1. Barriers and Facilitators to Health Services for People with Disabilities in Cambodia: An exploratory study Photo: Fred Hollows Foundation / Sophavid Choum Photo: End the Cycle-CBM / Paul Garrett What we found Financial barriers such as transport costs, informal and formal fees were viewed as the most significant barrier. Quality of care provided by health services was seen as a barrier. Respondents reported issues such as uncaring health professionals, poor quality of treatment, lack of appropriate medication and low levels of knowledge on how to engage with people with disabilities. As a result of reduced educational and social opportunities people with disabilities were needed more information on their right to access health care, their entitlements, and where to seek appropriate services. People with disabilities were less likely to participate in community health information sessions. ‘Protective’ family attitudes, reduced opportunity to participate in community events, and lack of confidence in engaging with health professionals were amongst the sociocultural barriers faced by people with disabilities. Respondents reported barriers in accessing transport, and infrastructure of health services, but on the whole these issues were of secondary importance to affordability. Recommended approaches for inclusive health services : Strengthen implementation of national legislation protecting and promoting right to health care for people with disabilities. Ensure adequate financing within health system for inclusion. Create coordination mechanisms between ministries responsible for health and people with disabilities. Integrate disability into health sector strategic plans, and vertical programs such as sexual and reproductive health. Include disability into health training curriculum for medical professionals. For NGOs working in health, ensure people with disabilities are benefiting equally. Partner with Disabled People’s Organisations for advice, referrals and targeted activities. Why did we do this study? Accessing appropriate and affordable health services is a challenge for many people in a developing country context, but for Cambodian people with disabilities this challenge appears even more significant. Access to health services remains integral to the health and well-being of the individual and a fundamental human right. The United Nations Convention on the Rights of Persons with Disabilities emphasises the right of people with disabilities to enjoy equal access to all spheres of society including, specifically, the right to access mainstream health services. Barriers to health care are identifiable at the individual, service-point and systemic levels, and as such the impetus for improvement, and removal of barriers, also lies with a diverse set of stakeholders. What the study aims to do Explore the global context and local legislation, policies and health services which hinder or enable access to health services for Cambodian people with disabilities. Focus on ‘mainstream’ health services, i.e. the health services that any person may require, not disability specific services in the community, public and private health centres, referral and provincial hospitals as well as specialist medical hospitals and clinics. Map the barriers that people with disabilities face in accessing health care, as well as the facilitators which ease access to required services. Provide targeted recommendations to identified stakeholder groups from both the disability and health sectors. How was it done? Analysis of available literature and Cambodia-based key informant interviews were conducted with a diverse group of disability and health service stakeholders. A total of 63 in-depth semi-structured interviews were conducted over the study period from April 2010 through to August 2011 with key disability and health stakeholders across 4 Provinces, Phnom Penh, Takeo, Kandal and Kampot. Focus group consultations were held in June 2011 involving 49 participants, of whom some had previously been interviewed individually; in total there were 98 participants. A thematic analysis of the existing literature, key informant interviews and focus group consultation was conducted around key areas for policy and practice improvement. The study used Bidgeli’s (2009) framework for analysing barriers at five levels including physical, financial, sociocultural, quality of care and knowledge of users.