DOI: 10.3310/nihropenres.14343.1 ISSN: 2633-4402

Inequalities in access to health services between people with and without disabilities in sub-Saharan Africa: a systematic review

Emma Jolley, Bhavisha Virendrakumar, Stevens Bechange, Calum Davey, Hannah Kuper
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Background There are over 80 million people living with disabilities in sub-Saharan Africa (SSA). They often experience high health needs and a wide range of barriers in accessing healthcare services. This study aimed to systematically identify and synthesise the quantitative evidence describing the differences in access to healthcare services between people with and without disabilities in SSA. Methods We searched databases (EMBASE, Global Health, PsychInfo, SCOPUS, Web of Science, African Index Medicus, the SINTEF library, and Google Scholar), websites, and reference lists for eligible documents published in any language between January 2000 and November 2025. Eligible studies used a quantitative design to compare healthcare access (utilization, coverage, adherence, affordability, quality) between people with and without disabilities in the World Bank Africa Region. Results We retrieved 12,903 documents and included 52 in our review, most of which were assessed to be of low (n = 36) or medium risk of bias (n = 13), using the SIGN-50 checklists. The studies reported 103 outcomes which we categorised as related to utilisation (n = 12), coverage (n = 60), adherence (n = 10), financial coverage (n = 17), or quality (n = 4). Conclusions Outcomes related to utilisation, adherence and quality were mixed or inconclusive. Outcomes related to coverage and financial coverage generally suggested lower access by people with disabilities; however, a large proportion of null and mixed findings prevent us from drawing strong conclusions. Future primary research should focus on improved conceptualisation and measurement of disability and strengthening the use of comparable outcome measures in health research and data collection.

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