Are primary healthcare facilities in Ethiopia complying with accessibility standards for disability-inclusion? an accessibility audit in Bahir Dar City.

BACKGROUND

Accessible health facilities are a crucial component of disability-inclusive healthcare. Yet audits are rarely undertaken, particularly in Low- and Middle-Income Countries (LMICs). This study evaluated the accessibility of Ethiopia's primary healthcare facilities to determine its readiness for delivering disability-inclusive services. Furthermore, it proposes actionable solutions to guide national efforts in strengthening health system inclusivity.

METHODS

A cross-sectional accessibility audit was conducted across all 10 public primary healthcare facilities in Bahir Dar, Ethiopia. We collected data through a structured Disability Awareness Checklist, using face-to-face, participatory and action-oriented interviews with medical directors. This was complemented by direct observations of facility premises, and physical measurements (e.g. ramp slopes) across four dimensions: universal design, reasonable accommodation, staff capacity, and disability service linkages. We computed median percentage accessibility scores and compared between urban and rural facilities using Mann-Whitney U and Kruskal-Wallis tests. Additionally, Spearman's correlation was used to examine relationships between accessibility, patient flow, and staffing levels. Finally, facility staff co-proposed tailored action plans to address identified gaps.

RESULTS

The median overall accessibility score was 35% (range: 14-60%; maximum possible 100%), with urban facilities (42%) scoring higher than rural (18%). By dimension, the highest scores were for reasonable accommodation (47%), followed by staff capacity (42%) and universal design (31%). The lowest performance was recorded in linkages to disability-related services (8%). Differences in median accessibility scores were observed across facilities (χ² = 22.8, p ≤ 0.01) and core dimensions (χ² = 8.9, p < 0.05). Accessibility was strongly and positively correlated with both annual patient volume (ρ = 0.84, p < 0.01) and staff size (ρ = 0.83, p < 0.01). A median of 30 recommendations were proposed, with 45% requiring "high" funding, while 22% were identified as cost-free.

CONCLUSION

Accessibility standards for disability inclusion remain largely unmet across primary healthcare facilities in Ethiopia, with marked urban-rural disparities. This undermines the goals of equity and universal health coverage targeted for 2030. Closing these health equity gaps requires strengthening the health system through improved infrastructure, upgraded staff capacity for compassionate care, and stronger referral linkages. Furthermore, these measures are ultimately essential for guaranteeing inclusive, accessible, and rights-based primary care services, particularly in rural contexts.