Challenges In Accessing Primary Healthcare For Children With Disabilities In Enugu State: Perspectives From Health Workers

Access to quality primary healthcare (PHC) is a core pillar of Universal Health Coverage (UHC). However, children with disabilities (CWDs) continue to experience disproportionate barriers to healthcare access, particularly in low- and middle-income countries. Evidence on these challenges from the perspectives of frontline health workers remains limited in Nigeria. A qualitative phenomenological study was conducted in Enugu State, southeastern Nigeria. Purposively selected health workers from primary healthcare facilities serving special schools participated in in-depth interviews and focus group discussions. Non-participant observations were also undertaken to contextualize service delivery. Data were audio-recorded, transcribed verbatim, and analyzed thematically using an inductive approach. Health workers reported multiple, interrelated barriers affecting access to PHC for CWDs. Key challenges included significant communication difficulties due to children’s intellectual and sensory impairments, inadequate disability-inclusive training among health workers, transportation and physical accessibility constraints, shortages of human and material resources, and limited awareness of health policies and entitlements for CWDs. These barriers often resulted in delayed diagnosis, reliance on clinical guesswork, repeated referrals, and suboptimal quality of care. Access to PHC for children with disabilities in Enugu State is constrained by systemic, institutional, and structural barriers that undermine equity and quality of care. Addressing these challenges requires targeted capacity building for health workers, improved disability-friendly infrastructure, strengthened intersectoral collaboration, and effective dissemination of disability-related health policies. Integrating disability inclusion into PHC reforms is essential for advancing UHC and ensuring that no child is left behind.