Access to healthcare and assistive technologies for people with physical disabilities in Cambodia

Abstract

Access to healthcare and assistive technology, including assistive products such as orthoses and wheelchairs, for people with disabilities is a fundamental human right, as stated in the United Nations Convention of the Rights of People with Disabilities. Evidence suggests that people with disabilities face barriers to accessing health and rehabilitative care in Low- and Middle-Income Countries. The overarching aim of this thesis is to investigate access to healthcare services and assistive products for people with physical disabilities in Cambodia. This three-paper thesis seeks contribute to the limited literature on this topic. The first two papers, in Chapters 4 and 5 apply quantitative methods using data from the Cambodian Socio-Economic Survey and from a patient database of service users from three Prosthetic and Orthotic clinics in Cambodia. Chapter 4 seeks to understand differences in access to health services between people with and without physical disabilities using a two-stage Hurdle Model. Chapter 5 follows on from this by investigating a specific population group, orthosis users, and their access to Prosthetic and Orthotic services. In this study, descriptive statistics have been used to examine change in use over time, and survival analysis has been used to investigate differences in orthotic device replacements. The final empirical chapter, Chapter 6, adopts a qualitative design to explore pathways to physical rehabilitation services, and the barriers and facilitators for orthosis and wheelchair users. In this thesis, there are some key findings. Firstly, poverty impacts access to health and physical rehabilitation services for people with disabilities in Cambodia. Secondly, gender and disability intersect to create differences in access between men and women. Thirdly, use of prosthetic and orthotic services has changed over time, with administrative data providing an effective way of studying this change. Lastly, several facilitators of access to physical rehabilitation services were found, including social support networks, community health workers and individual agency. The finding from the thesis indicate that people with disabilities in Cambodia have differential access to health and physical rehabilitation. The findings in this thesis have important policy implications as understanding where people with disabilities are seeking healthcare and the significant barriers to health and rehabilitation is vital for designing patient-centred services in Cambodia and other low- and middle-income countries.

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Identifiers

ORCID for Amos Channon: orcid.org/0000-0003-4855-0418

ORCID for (Andy) Power: orcid.org/0000-0002-3887-1050

ORCID for Kristine Nilsen: orcid.org/0000-0003-2009-4019

ORCID for Nikos Tzavidis: orcid.org/0000-0002-8413-8095

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