Policy Implementation Challenges and Barriers to Access Sexual and Reproductive Health Services Faced By People With Disabilities: An Intersectional Analysis of Policy Actors' Perspectives in Post-Conflict Northern Uganda.
Policy Implementation Challenges and Barriers to Access Sexual and Reproductive Health Services Faced By People With Disabilities: An Intersectional Analysis of Policy Actors' Perspectives in Post-Conflict Northern Uganda.
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DOI：
10.34172/ijhpm.2021.28
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发表时间：
2022-07-01
影响因子：
3.5
通讯作者：
Zarowsky C
中科院分区：
文献类型：
--
作者：
Mac-Seing M;Ochola E;Ogwang M;Zinszer K;Zarowsky C
背景资料：乌干达刚刚摆脱20年的武装冲突，通过了若干法律和政策，以保护残疾人的权利，包括他们的性健康和生殖健康权利。然而，在乌干达，残疾人的性健康和生殖健康权利继续受到侵犯。我们探讨了政策行为者对现有的有利于残疾人的立法和政策执行的看法，他们对冲突后北方乌干达残疾人在获得和使用性健康和生殖健康服务方面遇到的潜在障碍的看法，以及他们关于如何纠正这些不公平现象的建议。 研究方法：通过交叉性的方法，我们对宏观层面的政策参与者进行了13次深入的半结构化访谈，并进行了主题分析（国家决策者和国际及国家组织）; 7个中间一级的重点小组，有68个保健服务提供者和残疾人组织的代表;以及为34名保健服务提供者举办了为期两天的关于提供对残疾问题有敏感认识的保健服务的参与性讲习班。 结果如下：我们确定了四个主要主题：（1）立法和政策实施充满了众多技术和财政挑战，加上缺乏对残疾问题的优先考虑;（2）残疾人在获得和使用性健康和生殖健康服务方面遇到了多种身体、态度、沟通和结构性障碍;（3）人们认为冲突对获得服务产生了持续影响;以及（4）政策参与者建议了具体的解决方案，以减少残疾人面临的卫生不平等。 结论：这项研究提供了大量证据，表明残疾人在使用性健康和生殖健康服务时面临多层次的不利条件，以及在乌干达实施以残疾为重点的政策的困难。政策行动者通过了解交叉性办法，能够在查明问题之外确定具体的解决办法和建议。这些建议可以在一个切实可行的路线图中得到落实，以消除残疾人在获得性健康和生殖健康服务方面的各种障碍，无论他们在乌干达的地理位置如何。
Background: Emerging from a 20-year armed conflict, Uganda adopted several laws and policies to protect the rights of people with disabilities, including their sexual and reproductive health (SRH) rights. However, the SRH rights of people with disabilities continue to be infringed in Uganda. We explored policy actors’ perceptions of existing pro-disability legislation and policy implementation, their perceptions of potential barriers experienced by people with disabilities in accessing and using SRH services in post-conflict Northern Uganda, and their recommendations on how to redress these inequities. Methods: Through an intersectionality-informed approach, we conducted and thematically analysed 13 in-depth semi-structured interviews with macro level policy actors (national policy-makers and international and national organisations); seven focus groups (FGs) at meso level with 68 health service providers and representatives of disabled people’s organisations (DPOs); and a two-day participatory workshop on disability-sensitive health service provision for 34 healthcare providers. Results: We identified four main themes: (1) legislation and policy implementation was fraught with numerous technical and financial challenges, coupled with lack of prioritisation of disability issues; (2) people with disabilities experienced multiple physical, attitudinal, communication, and structural barriers to access and use SRH services; (3) the conflict was perceived to have persisting impacts on the access to services; and (4) policy actors recommended concrete solutions to reduce health inequities faced by people with disabilities. Conclusion: This study provides substantial evidence of the multilayered disadvantages people with disabilities face when using SRH services and the difficulty of implementing disability-focused policy in Uganda. Informed by an intersectionality approach, policy actors were able to identify concrete solutions and recommendations beyond the identification of problems. These recommendations can be acted upon in a practical road map to remove different types of barriers in the access to SRH services by people with disabilities, irrespective of their geographic location in Uganda.
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影响因子：
3.4
作者：
Ahumuza SE;Matovu JK;Ddamulira JB;Muhanguzi FK
通讯作者：
Muhanguzi FK
影响因子：
2.2
作者：
Hulko, Wendy
通讯作者：
Hulko, Wendy
影响因子：
6
作者：
Mac-Seing M;Zinszer K;Eryong B;Ajok E;Ferlatte O;Zarowsky C
通讯作者：
Zarowsky C
影响因子：
1.6
作者：
Hollander, Theo;Gill, Bani
通讯作者：
Gill, Bani
影响因子：
3
作者：
Chi, Primus Che;Bulage, Patience;Sundby, Johanne
通讯作者：
Sundby, Johanne