Delivering disability-inclusive eye care for older people in northern Uganda: a qualitative study of provider experiences using the Levesque framework

Abstract Background Population ageing is accelerating rapidly, resulting in rising numbers of older people with functional limitations and morbidities including vision impairment. Despite Uganda having a supportive disability-inclusive health policy framework, older people with disabilities have high unmet eye health care needs. This study sought to explore the challenges and facilitators to providing quality eye health services to older people with disabilities in Karamoja from the perspective of health care workers. This paper complements an existing published paper describing the experiences of older people with disabilities. Methods This was a descriptive qualitative study using in-depth interviews to generate data. We purposively selected 13 health workers involved in eye health services at the national, regional, district and village levels. Informed consent was sought and obtained. Interviews were guided by pre-developed guides, audio-recorded, transcribed and translated where needed. Data were analysed using a combination of inductive and deductive coding. Findings were presented using the supply-side dimensions of the Levesque conceptual framework of access to healthcare. While many barriers are common to service provision for all older people, we focused on those specific to older people with disabilities. Results Participants described interlinked challenges across all five domains of the framework, with age- and disability-related stigma overlapping and reinforcing barriers throughout. Approachability was constrained by limited and non-inclusive health messaging. Acceptability was affected by the local understanding of ageing, and poverty shaping household decisions. Availability and accommodation were undermined by long distances, poor transport infrastructure, inaccessible facilities, limited outreach, and limited assistive technology. Affordability barriers centred on indirect costs such as transport and food. Appropriateness was compromised by insufficient staffing, equipment shortages, weak coordination with social support systems, and limited training on disability inclusion and communication with patients with severe and complex impairments. Conclusions Health workers described a range of challenges that include age- and disability- related stigma, dependence on implementing partners, and low levels of development in Karamoja. While findings are shaped by the unique context of the sub-region, they offer valuable insights that can inform more responsive, integrated approaches to health care for older people with disabilities.