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Purpose: This review and meta-synthesis of qualitative studies aims to provide an overview of qualitative evidence on primary healthcare access of people with disability in Latin America and the Caribbean, as well as to identify barriers that exist in this region. Methods: Six databases were searched for studies from 2000 to 2022. 34 qualitative studies were identified. Results: Barriers exist on both demand and supply sides. The thematic synthesis process generated three broad overarching analytical themes, which authors have related to Levesque et al.'s aspects of "ability to perceive," "availability, accommodation and ability to reach" and "appropriateness and ability to engage." Access to information and health literacy are compromised due to a lack of tailored health education materials. Barriers in the urban environment, including inadequate transportation, and insufficient healthcare facility accessibility create challenges for people with disabilities to reach healthcare facilities independently. Attitudinal barriers contribute to suboptimal care experiences. Conclusion: People with disabilities face several barriers in accessing healthcare. Lack of healthcare provider training, inappropriate urban infrastructure, lack of accessible transport and inaccessibility in healthcare centers are barriers that need to be addressed. With these actions, people with disabilities will be closer to having their rights met. IMPLICATIONS FOR REHABILITATION: The identification of barriers on both the supply and demand sides highlights implications for individuals with disabilities seeking access to primary healthcare services, primarily in Brazil, with similar concerns noted in Colombia and Trinidad and Tobago. Service providers should enhance access to people with disabilities by providing accessible information and reasonable accommodation for people with disabilities. More training of healthcare professionals is required to support the provision of care for people with disabilities. There is a need to improve healthcare centre accessibility, as well as local infrastructure and transportation to prevent people with disabilities from having their rights violated. Linkages should be strengthened between sectors like transportation, urban development, and health to enhance overall accessibility and prevent violations of the rights of individuals with disabilities. [ABSTRACT FROM AUTHOR]

Organisations of Persons with Disabilities (OPDs) are critical to promoting and protecting the rights of people with disabilities. However, little is known about the extent to which people with disabilities are aware and members of OPDs. This study uses data from nine population-based surveys in low- and middle-income countries to explore OPD awareness and membership. Across settings, about a third of people with disabilities were aware of OPDs and fewer than 15% were members. Awareness and membership were lower amongst older adults, women, people with difficulties communicating, remembering and with self-care, people with less education, in poverty and in rural areas. Underrepresentation of certain groups may indicate a need to seek out the voices of people less likely to be associated with OPDs. Further, low total membership may be a cause for concern in settings where OPDs are relied upon to deliver essential services in the absence of state structures. Points of interest: Organisations of Persons with Disabilities can serve many roles, including advocacy, policymaking and service provision. The increasing involvement of Organisations of Persons with Disabilities in direct provision of essential services, particularly in low- and middle-income countries, is often a result of poor availability and quality of inclusive public services. This study explores awareness and membership of people with disabilities across nine low- and middle-income countries using population-based surveys. About a third of people with disabilities were aware of Organisations of Persons with Disabilities across settings, ranging from 12% in Lesotho to 73% in the Maldives. Fewer than 15% of people with disabilities were members across settings, ranging from 3.5% in Zambia to 14% in Vietnam (Cam Le district). Awareness and membership were generally lower amongst older adults, women, people with difficulties communicating, remembering and with self-care, people with less education, in poverty and in rural areas. Given the increased role of Organisations of Persons with Disabilities in direct service delivery, low total membership may indicate that many people with disabilities – particularly the most marginalised or experiencing the greatest need – are not being reached. Additional efforts may also be needed to seek out the voices of groups underrepresented in Organisations of Persons with Disabilities, particularly for advocacy and policymaking. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic had profound impacts on education globally. The pandemic widened educational disparities between young people with and without disabilities, but accounts from low- and middle-income countries are missing from the literature. This article reports on a multi-country qualitative study of experiences of education in low- and middle-income countries during the pandemic. Interviews were conducted with primary, secondary, and tertiary-level young people with disabilities who were engaged in education, and caregivers, with 30–60 participants per country. Data were analysed using thematic analysis, organised according to three key topics: experiences accessing education prior to the pandemic, barriers to access during the pandemic, and the impact of poor access. The pandemic exacerbated the existing failure of education systems to cater to the needs of people with disabilities and their families. Beyond education, losses in functioning, mental health, and family wellbeing were acutely felt by caregivers. [ABSTRACT FROM AUTHOR]

Little is known about what works to facilitate disability-inclusive employment. This study reports initial findings of a process evaluation of a disability-inclusive employment programme, STAR+, being implemented across Bangladesh. The study interrogates the design of STAR+ and the structures and processes by which it was delivered. Findings reveal an important role of early involvement of disability-focused organizations in intervention planning. The study further discusses adaptations made during STAR+ delivery. First, in some project areas, extra resources were available to appoint additional staff to support disability inclusion. Second, family members were relied upon by implementers to support youth with disabilities at their workplace and classroom training. Lastly, STAR+ implementers take care to ensure the right employers are selected by the programme, in some cases engaging in additional ad-hoc selection processes to on-board more altruistic individuals. Results are discussed in terms of programmatic and policy implications. [ABSTRACT FROM AUTHOR]