Beyond physical access: disability-inclusive primary health care as a test of health equity in Sub-Saharan Africa

Disability inclusion in primary health care is not a peripheral issue but a fundamental test of whether health systems in sub-Saharan Africa are advancing health equity and universal health coverage. Persons with disabilities experience persistent and overlapping barriers across the care pathway, including physical inaccessibility, unaffordable services, inaccessible information, poor provider communication, stigma, weak referral systems, and limited access to rehabilitation and assistive technology. These barriers are intensified by poverty, gender inequality, rural residence, and under-resourced health systems, producing avoidable inequities in access, quality, continuity, and financial protection. This commentary argues that disability-inclusive primary health care should be reframed from a narrow focus on physical access to a broader agenda of health-system accountability. Drawing on recent evidence from sub-Saharan Africa, it highlights how exclusion is embedded in routine system design, financing, workforce capacity, data systems, and governance. The paper further argues that meaningful inclusion requires disability-disaggregated monitoring, accessible communication, reasonable accommodation, provider training, strengthened referral pathways, financing for rehabilitation and assistive products, and formal participation of persons with disabilities and their representative organizations in planning and oversight. Disability-inclusive primary health care is therefore not a specialist add-on, but a core measure of whether universal health coverage reforms are genuinely equitable, people-centered, and resilient. Embedding disability inclusion into routine primary health care performance systems offers a practical pathway to stronger accountability and more inclusive health systems across sub-Saharan Africa.