Integrating Disability Audits into Health Systems: Evidence on Barriers to Accessible Health Services lymphatic filariasis care in Ghana

Introduction: Health systems in low- and middle-income countries (LMICs) are often unable to adequately address the needs of persons with disabilities (PWDs). One key challenge is the limited accessibility of healthcare facilities for persons with disabilities seeking care including those affected by lymphatic filariasis. As part of efforts to improve access to healthcare services for persons affected with lymphatic filariasis in Ghana, an accessibility audit checklist was piloted in selected health facilities across the country. Methods: A cross-sectional accessibility audit was conducted across 15 health facilities (HFs) in Ghana, using an eight-domain questionnaire disability audit checklist developed by Sightsavers. Data collection was done through on-site visits to the health facilities and face- to -face interviews with the management of the facilities visited. The data were examined using descriptive statistics. Results: The Sightsavers Accessibility Audit Checklist consists of 171 items. Out of 15 health facilities, Seven (46.7%) had moderate (score = 51–75%) and 8 (53.3%) had low accessibility (score = 26–50%). Most HFs (80.0%) were easy to find, many HFs (42.9%) had accessible circulation pathway ramps and doors, however, only two (13.3%) had accessible toilets, one (6.7%) had an accessible shower, and none had lifts or wheelchair platform stairlifts or accessible parking bays. Conclusion: Disability-inclusive accessibility standards remain largely unmet across primary healthcare facilities assessed in Ghana. Achieving universal health coverage (UHC) requires the institutionalization of disability-inclusive facility standards, supported by robust audit-driven accountability mechanisms. These considerations should be integrated into the planning, design, and renovation of health facilities in LMICs to ensure equitable access to healthcare for persons with disabilities.