Why rural healthcare is failing persons with disabilities

Access to healthcare is a human right and a cornerstone of universal health coverage (UHC). Yet for millions of persons with disabilities around the world, receiving even basic health services remains a difficult and uncertain journey. In Bangladesh, the government has made notable efforts to improve disability rights. The Rights and Protection of Persons with Disabilities Act 2013 recognises healthcare access as a fundamental right, while the operation of over 13,000 community clinics is designed to bring essential health services closer to rural populations. Despite these institutional advances, the everyday experiences of persons with disabilities, especially in rural regions, reveal significant gaps between policy commitments and practical realities.

According to the International Labour Organization (ILO) approximately 2.8 percent of Bangladesh’s population lives with some form of disability. However, researchers and disability advocates often argue that the real figure may be higher due to underreporting and social stigma. In rural communities where poverty, limited mobility, and lack of information intersect, persons with disabilities often face compounded challenges in seeking healthcare. One of the most overlooked barriers is the absence of clear and accessible referral systems within rural healthcare networks.

During recent fieldwork in Jashore, Jhalakathi, Habiganj, Sirajganj, Kurigram, and Mymensingh as part of a study by the BRAC Institute of Governance and Development (BIGD) at BRAC University, we encountered a recurring pattern illustrating the challenge. Many persons with disabilities and their caregivers reported that they do not know where to seek treatment or which doctor is capable of addressing their specific health needs.

In principle, Bangladesh’s healthcare system follows a structured referral pathway from community clinics to upazila health complexes, district hospitals, and specialised facilities. In practice, however, this pathway is rarely clear to rural patients.

A caregiver in Kurigram described the frustration of navigating this system: “First, we visited a village doctor who advised us to go to the district hospital. When we reached there, another doctor suggested a private clinic in another town. Each visit meant travel costs, consultation fees, and medicines, but we still did not know which doctor could properly treat my son.”

Without clear referral guidance, patients are often forced to move from one healthcare provider to another in a process of trial and error. This not only delays treatment but also places a heavy financial burden on already vulnerable households.

According to the World Bank, out-of-pocket payments account for more than 70 percent of total health expenditure in the country. For families caring for persons with disabilities who may require long-term medical attention, rehabilitation services, or assistive devices, these expenses can quickly become overwhelming. As a result, many families eventually reduce or completely stop seeking medical care. Untreated conditions may worsen over time, leading to additional disabilities, declining health, and increased economic hardship for families.

Another critical challenge is that many persons with disabilities and their caregivers have limited knowledge about available services, rehabilitation options, or specialised treatment facilities. In rural settings where digital access and health literacy remain uneven, this information gap significantly affects healthcare-seeking behaviour. Therefore, improving healthcare access for persons with disabilities is not only about building more hospitals or clinics. Rather, it requires strengthening the connections between existing health services and the communities they are meant to serve.

Rural community clinics could play a transformative role in promoting disability-inclusive healthcare. Community Health Care Providers (CHCPs) are often the most accessible healthcare professionals in rural communities. With proper training and institutional support, they could serve as local health navigators for persons with disabilities. CHCPs could help families identify appropriate healthcare facilities and specialists through structured referral guidance. Maintaining simple referral directories or communication channels with upazila hospitals and district-level specialists would greatly reduce confusion for patients.

Community clinics could also function as local information hubs. Persons with disabilities and their caregivers frequently need guidance on where to find physiotherapy, rehabilitation services, or assistive devices. Providing reliable information at the community level would help families make informed healthcare decisions. Moreover, home-based outreach services could significantly improve access for individuals with mobility challenges. Regular visits by community health workers would enable persons with disabilities to receive basic services such as health monitoring, medication distribution, or injections without the burden of travelling long distances.

Better coordination between community clinics and specialised disability services is essential. Collaboration with rehabilitation centres, physiotherapists, and disability-focused organisations could ensure that patients receive comprehensive care rather than fragmented treatment. Finally, addressing social attitudes towards disability within healthcare settings remains critical. Training health workers to adopt inclusive practices and respectful communication can help reduce stigma and ensure that persons with disabilities receive dignified care.

Bangladesh has already demonstrated that community-based health interventions can achieve remarkable success. Extending this community-oriented approach to disability-inclusive healthcare could significantly improve access and outcomes for millions of citizens. The challenge now is not merely expanding infrastructure, but ensuring that existing health systems work effectively for everyone. If Bangladesh is truly committed to inclusive development, then ensuring accessible healthcare for persons with disabilities in rural communities must become a national priority.

Md. Al-Mamun is research associate at the BRAC Institute of Governance and Development (BIGD), BRAC University.

Marufa Alam is lecturer in the Department of Public and Community Health at Frontier University Garowe in Somalia.

Views expressed in this article are the author's own. 

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