Access to primary health care among persons with disabilities in three selected districts of Zambia: determinants and experiences during the COVID-19 pandemic

Progress has been made in recent years in addressing inequalities among Persons with Disabilities (PWDS), but there is still a lot to be done in most of the sub-Saharan African countries. The unfair conditions experienced by PWDs across all aspects of life, including within the Primary Health Care (PHC) system, are responsible for inadequate access to primary health services, which could result in adverse health outcomes. There is a need to improve access to PHC services for Persons with Disabilities in Zambia’s communities to foster the achievement of universal health coverage by 2030. The COVID-19 pandemic has further widened these inequalities, particularly impacting PWDs. Our research aimed to examine the determinants of access to primary health care among persons with disabilities in Zambia and explore their experiences during the COVID-19 pandemic. The study used a mixed-methods concurrent approach, with a qualitative component involving focus group discussions and a quantitative component consisting of a cross-sectional study that used structured questionnaires conducted in the three districts of Zambia (Lusaka, Mazabuka, and Monze). A total of 985 participants were interviewed, and Seven Focus Group Discussions were conducted. The WHO access to health dimension was used. Qualitative data was analysed thematically while quantitative data was analysed using descriptive statistics and log-binomial model analysis. StataCorp version 17 software was used for the analysis. The study established that the persisting challenges were the unavailability of instruction in reading braille, the lack of PHC sign language interpreters, and non-subscription to the national health insurance. Results from log-binomial model on access to PHC among participants were that individuals with minor disability (aPR: 7.32, 95% CI: 4.14–12.94), moderate disability (aPRs: 1.27, 95% CI: 1.07–1.51), primary education (aPR: 1.68, 1.11–2.53) secondary education (1.67: 1.11–2.51), tertiary education (aPR: 2.28,95% CI: 1.46–3.56) were more likely to access primary health care. Mazabuka District (aPR, 0.78, 95% CI: 0.63–0.97) spinal cord impairment (aPR: 0.76, 95% CI: 0.61–0.95), vision disability (aPR, 0.38 95% CI: 0.27–0.55), cognitive disability (aPR, 0.50 95% CI: 0.32–0.79) hearing disability (aPR 0.45, 95% CI: 0.21–0.97) were less likely to access primary health care. The study revealed that access to primary health care among persons with disabilities in Zambia and experiences during the COVID-19 pandemic were significantly constrained across all five WHO access dimensions. There is a need to ensure that access to PHC among Persons with Disabilities is improved to achieve universal health coverage.