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Purpose: Health should be a universal phenomenon. However, little is known about the relationship between disability status and health issues – particularly in rural areas. This study looks at health issues of persons with disabilities in Madwaleni, a rural impoverished area in South Africa in 2011, and compares them to persons with no disabilities. Materials and Methods: Standardized questionnaires were used in the survey to assess disability and health status. The sample comprised of 773 individuals – 322 persons with disability and 451 comparisons (without disability) – covering 527 households. Children under the age of five were excluded from the sample. We used purposive sampling. Results and Conclusion: This study found that persons with disabilities have poorer reported health outcomes than persons with no disabilities. There is also an association between disability severity and mental health issues as assessed by the GHQ-12. A significantly higher percentage of persons with disability did not get health care when needed. Persons with disabilities also have less favorable attitudes toward competence of health care workers. This study has shown greater health needs and less satisfaction with services, which strongly indicates insufficient access for persons with disabilities in a rural impoverished are within South Africa. •Implications for rehabilitation •Persons with disabilities in rural South Africa have poorer reported health outcomes. •Persons with disabilities have less favorable attitudes towards competence of health care workers in rural South Africa. •Better access to health care for persons with disabilities is needed in rural South Africa. The perceived needs-access gap for health services among persons with disabilities in a rural area within South Africa

In this paper, the current situation regarding rural mental health in South Africa is explored. The current status is presented, followed by an attempt to provide approaches and ideas to improve the situation in order to make it more context appropriate and relevant. Issues of staffing, task shifting or sharing, and formal vs informal health care systems are considered and discussed as possible future approaches to improve rural mental health care in South Africa.

Background: There are many factors that influence access to public health services, such as the context people live in, the existing health services, and personal, cultural and community factors. People with disabilities (activity limitations), through their experience of health services, may offer a particular understanding of the performance of the health services, thus exposing health system limitations more clearly than perhaps any other health service user.Aim: This article explores how activity limitations interact with factors related to context, systems, community and personal factors in accessing public health care services in South Africa.Setting: We present four case studies of people with disabilities from four low-resource diverse contexts in South Africa (rural, semi-rural, farming community and peri-urban) to highlight challenges of access to health services experienced by people with activity limitations in a variety of contexts.Methods: One case study of a person with disabilities was chosen from each study setting to build evidence using an intensive qualitative case study methodology to elucidate individual and household experiences of challenges experienced by people with activity limitations when attempting to access public health services. In-depth interviews were used to collect data, using an interview guide. The analysis was conducted in the form of a thematic analysis using the interview topics as a starting point.Results: First, these four case studies demonstrate that equitable access to health services for people with activity limitations is influenced by a complex interplay of a variety of factors for a single individual in a particular context. Secondly, that while problems with access to public health services are experienced by everyone, people with activity limitations are affected in particular ways making them particularly vulnerable in using public health services.Conclusion: The revitalisation of primary health care and the introduction of national health insurance by the Health Department of South Africa open a window of opportunity for policy makers and policy implementers to revisit and address the areas of access to public health services for people with activity limitations.

Background Global research suggests that persons with disabilities face barriers when accessing health care services. Yet, information regarding the nature of these barriers, especially in low-income and middle-income countries is sparse. Rural contexts in these countries may present greater barriers than urban contexts, but little is known about access issues in such contexts. There is a paucity of research in South Africa looking at “triple vulnerability” – poverty, disability and rurality. This study explored issues of access to health care for persons with disabilities in an impoverished rural area in South Africa. Methods The study includes a quantitative survey with interviews with 773 participants in 527 households. Comparisons in terms of access to health care between persons with disabilities and persons with no disabilities were explored. The approach to data analysis included quantitative data analysis using descriptive and inferential statistics. Frequency and cross tabulation, comparing and contrasting the frequency of different phenomena between persons with disabilities and persons with no disabilities, were used. Chi-square tests and Analysis of Variance tests were then incorporated into the analysis. Results Persons with disabilities have a higher rate of unmet health needs as compared to non-disabled. In rural Madwaleni in South Africa, persons with disabilities faced significantly more barriers to accessing health care compared to persons without disabilities. Barriers increased with disability severity and was reduced with increasing level of education, living in a household without disabled members and with age. Conclusions This study has shown that access to health care in a rural area in South Africa for persons with disabilities is more of an issue than for persons without disabilities in that they face more barriers. Implications are that we need to look beyond the medical issues of disability and address social and inclusion issues as well.

Received 16 August 2012; revised 23 November 2012; accepted 10 December 2012Background: The global mental health movement has supplied ample evidence of treatment gaps for mentalhealth care in low and middle-income countries. It is also clear that substantial progress has been made indeveloping an evidence base for innovative treatments which have been shown to work. It is only throughrich and detailed understandings of local contexts and individual experiences that the challenges globalmental health faces can be fully appreciated.Methods: In this article, we use a single, qualitative case study from one context and of one family affected bymental disorder. This is to elucidate core issues which we regard as key to further developments in the globalmental health agenda.Results: Core issues are poor mental health literacy, transport and lack of outreach, limitations of formal healthcare, challenges at the interface with indigenous health care and lack of follow-up and rehabilitation.Conclusion: We propose shifting the focus of mental health care from cure to promotion and prevention, usingan interdisciplinary team of lay and trained health workers from the professional, folk and popular sectors. Thechallenges are complex, as this small study shows, but it is only by looking closely at local conditions that it ispossible to develop interventions which are contextually appropriate and make optimal use of local resources.Keywords: Mental disorder, Mental health service, Rural, Poverty, South Africa, Community mental health

Background : There is international evidence that people with disabilities face barriers when accessing primary healthcare services and that there is inadequate information about effective interventions that work to improve the lives of people with disabilities, especially in low-income and middle-income countries. Poor rural residents generally experience barriers to accessing primary healthcare, and these problems are further exacerbated for people with disabilities. Objective : In this study, we explore the challenges faced by people with disabilities in accessing healthcare in Madwaleni, a poor rural Xhosa community in South Africa. Design : Purposive sampling was done with 26 participants, using semi-structured interviews and content analysis to identify major themes. Results : This study showed a number of barriers to healthcare for people with disabilities. These included practical barriers, including geographical and staffing issues, and attitudinal barriers. Conclusions : It is suggested that although there are practical barriers that need to be addressed, attitudinal barriers could potentially be addressed more easily and cost effectively. Keywords : disability; rural; access; health; barriers (Published: 1 October 2015) Citation: Glob Health Action 2015, 8 : 29003 - http://dx.doi.org/10.3402/gha.v8.29003