PURPOSE: This paper explores the barriers which people with disabilities experience in accessing health care services in Malawi. METHODOLOGY: Fifty-two in-depth interviews were conducted with people with various types of disabilities. These interviews were conducted in four districts in Malawi: Blantyre and Phalombe in the Southern Region; Ntchisi in the Central Region, and Rumphi in the North. A team of trained research assistants conducted the interviews. RESULTS: The major challenges that people with disabilities experience include the cost of accessing health care, long distances to health facilities, lack of transport, hilly terrains and flooding of rivers during the rainy season, communication challenges with the health providers and poor attitude of health workers. Some of these challenges are not unique to people with disabilities, but constitute more of a problem among people with disabilities. CONCLUSION: There is a need to address these challenges through the expansion of the provision of assistive devices, implementing comprehensive outreach services targeting people with disabilities and strengthening the links between key component of access to quality health care. Attitudinal barriers and lack of resources remain major challenges. Implications for rehabilitation Though people with disabilities face challenges accessing health care world-wide, the challenges are greater in low-income countries. The current study in Malawi confirms this. Major challenges include costs of care, transport costs, and inaccessible facilities. Lack of health worker awareness and attitudinal barriers are major issues of concern. It is imperative, given this situation, that effort is spent in Malawi and similar contexts on dealing with issues of stigma and discrimination especially in the health care sector. It is also important to explore cost-effective ways of assisting people with disabilities accessing appropriate transport, which should be seen as part of the healthcare system. Though the cost of providing equitable care may be high in low-income contexts, this is a human right. Training and creating an accessible and disability-friendly service environment is a key priority.

b Department of Psychology Alan J Flisher Centre for Public Mental Health Stellenbosch University Stellenbosch South Africa

c School of Nursing Midwifery and Health University College Dublin Dublin Ireland

Centre for Social Research University of Malawi Zomba Malawi

g Department of Sociology Chancellor College University of Malawi Zomba Malawi

h Chancellor College University of Malawi Zomba Malawi

Maynooth ALL Institute and Department of Psychology Maynooth University Ireland e Centre for Rehabilitation Studies Stellenbosch University Tygerberg South Africa f Olomouc University Social Health Institute Palacky University Olomouc Czech Republic

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