Assessing the inclusion of people with disabilities in the health system in Ethiopia.
1
Department of Population Health, London School Of Hygiene & Tropical Medicine, London, United Kingdom
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Over 1.3 billion people globally live with disabilities and experience substantial health disadvantages. Yet evidence on how health systems in low-income countries respond to their needs remains limited. This study aimed to assess disability inclusion within Ethiopia’s health system.
METHODS:
We applied a mixed-methods approach. A systematic review assessed life expectancy differences between people with and without disabilities in low- and middle-income countries. Quantitative analysis of nationally representative Ethiopian Socio-Economic Panel Survey data examined inequalities in health status, healthcare utilisation, and expenditure by disability status. Qualitative in-depth interviews with 30 adults with disabilities in Ethiopia explored their healthcare access experiences. An audit evaluated compliance of primary healthcare facilities with disability accessibility standards in Bahir Dar, Ethiopia. Finally, a policy content analysis using the Equi-Frame tool assessed the integration of disability rights within national health policy documents.
RESULTS:
The systematic review found substantially lower life expectancy among people with disabilities (58 years) compared with those without (71 years). Ethiopian national survey data showed that people with disabilities were more likely to report illness (AOR = 2.91; 95% CI: 1.56–5.43) and incurred much higher healthcare costs (US$134 vs. US$38; p = 0.04). Yet, these greater needs were not matched by increased healthcare utilisation. Qualitative findings identified intersecting barriers to care, including inaccessible infrastructure, negative provider attitudes, unaffordable services, and limited rehabilitation services. Facility audits confirmed poor accessibility (median score = 35%), particularly for rural facilities. Policy analysis revealed fragmented disability integration, and critical gaps in references to financing, information systems, and fundamental human rights within the policies.
CONCLUSIONS:
Persons with disabilities remain systematically excluded from Ethiopia’s health system. Addressing these gaps requires coordinated, rights-based reforms grounded in lived experience and implemented through a twin-track approach to ensure health equity and that no one is left behind.
Over 1.3 billion people globally live with disabilities and experience substantial health disadvantages. Yet evidence on how health systems in low-income countries respond to their needs remains limited. This study aimed to assess disability inclusion within Ethiopia’s health system.
METHODS:
We applied a mixed-methods approach. A systematic review assessed life expectancy differences between people with and without disabilities in low- and middle-income countries. Quantitative analysis of nationally representative Ethiopian Socio-Economic Panel Survey data examined inequalities in health status, healthcare utilisation, and expenditure by disability status. Qualitative in-depth interviews with 30 adults with disabilities in Ethiopia explored their healthcare access experiences. An audit evaluated compliance of primary healthcare facilities with disability accessibility standards in Bahir Dar, Ethiopia. Finally, a policy content analysis using the Equi-Frame tool assessed the integration of disability rights within national health policy documents.
RESULTS:
The systematic review found substantially lower life expectancy among people with disabilities (58 years) compared with those without (71 years). Ethiopian national survey data showed that people with disabilities were more likely to report illness (AOR = 2.91; 95% CI: 1.56–5.43) and incurred much higher healthcare costs (US$134 vs. US$38; p = 0.04). Yet, these greater needs were not matched by increased healthcare utilisation. Qualitative findings identified intersecting barriers to care, including inaccessible infrastructure, negative provider attitudes, unaffordable services, and limited rehabilitation services. Facility audits confirmed poor accessibility (median score = 35%), particularly for rural facilities. Policy analysis revealed fragmented disability integration, and critical gaps in references to financing, information systems, and fundamental human rights within the policies.
CONCLUSIONS:
Persons with disabilities remain systematically excluded from Ethiopia’s health system. Addressing these gaps requires coordinated, rights-based reforms grounded in lived experience and implemented through a twin-track approach to ensure health equity and that no one is left behind.
| eISSN: | 2654-1459 |
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