He will never be a ‘normal’ person: a qualitative study of multi-level barriers to healthcare access for children with disabilities in Sindh, Pakistan

Children with disabilities face widespread exclusion from accessing appropriate healthcare, yet there is limited data, especially from low- and middle-income countries. This study aimed to explore barriers to accessing healthcare services among children with disabilities in Sindh Province, Pakistan. The exploratory qualitative study collected 22 in-depth interviews with healthcare providers and caregivers and six focus group discussions with children with disabilities aged 7–17 years. This study was conducted in four districts of Sindh from January to May 2023. Data was analyzed using deductive and inductive methods and presented in three different levels, such as individual, socio-cultural, and policy and system level, by using the socio-ecological framework. This study highlighted that children with disabilities face significant exclusion from accessing healthcare services, that are shaped by geographical, financial, structural and societal barriers across three domains of the socio-ecological model. At the individual and family level, caregivers and children reported having limited awareness regarding disability-related care, experienced financial constraints due to lack of insurance coverage. At the socio-cultural level, factors highlighted include stigma, discrimination during provider interaction, and inadequate social support. At the policy and system level, barriers included poor physical accessibility of health facilities, communication challenges to interact with healthcare providers, and substantial gaps in availability of rehabilitation services and assistive technologies. Healthcare access for children with disabilities requires comprehensive health system reforms to strengthen providers’ capacity and training, improve facility accessibility, enhance care coordination, and ensure affordable insurance for children with disabilities, in alignment with the Convention on the Rights of Persons with Disabilities.