How can access barriers be removed to ensure that people with psychosocial, developmental, and neurological disabilities can access all forms of healthcare?

Challenge #1: Country-specific policies and legal frameworks for inclusive healthcare for people with psychological, developmental, and neurological impairments (PDNI) are absent in many low-and middle-income countries (LMICs). 

• There are shortcomings in the legal and policy environment to support the provision of responsive and comprehensive healthcare for people with PDNI in LMICs. Consequently, people with PDNI face access barriers including unavailability, inadequacy, and sometimes total lack of certain healthcare services such as rehabilitation, since the broad policy guidelines are either unavailable or silent about the required services.  
• While most countries in LMICs have challenges with implementing the existing policies and legal frameworks for the healthcare of people with PDNI, others are yet to develop or update their policies and legal frameworks to guide the provision of healthcare services for people with PDNI.

Challenge #2: The healthcare workforce may not be adequately prepared to provide care

• Most resources, training, and health workforce capacity development have been directed toward addressing infectious diseases and reducing mortality and not directed towards addressing chronic and lifelong conditions such as PDNIs.  Task-shifting and task-sharing approaches may offer temporary but not long-term solutions to the existing training gaps. There are also reports of professional stigma which may negatively impact the readiness of people with PDNI from seeking care.
• Healthcare provision for people with PDNI must be coordinated based on the choices and preferences of people with PDNI and their caregivers. However, there is evidence of a lack of coordination, continuity, consistency, and disjointed care between the different departments, levels, and care providers in LMICs.

Challenge #3: People with PDNI face economic challenges which prevent access to all forms of healthcare.

• People with PDNI usually lack insurance coverage and plans to cover direct and indirect costs associated with seeking healthcare. In some instances, some services such as rehabilitative care or the costs for acquiring assistive devices may not at all be covered by the available insurance policies.
• They are also disadvantaged in accessing education, and gainful employment and may not fully get integrated into the communities to participate in socio-economic activities. Some of the challenges are related to societal stigma, beliefs, and attitudes, and not necessarily about their ability to participate in socio-economic activities.
• The healthcare systems in most LMICs lack sufficient resources for rehabilitation, and provision of assistive technology and devices because more resources have been prioritized towards addressing infectious diseases and reducing mortality.

Challenge #4: Societal barriers and lack of information contribute to healthcare inaccessibility.

• Myth-based beliefs concerning the aetiology or cause of PDNI are associated with societal stigma, discrimination, undesirable attitudes, and the non-utilization of healthcare services by people with PDNI.
• The lack of knowledge or information coupled with societal stigma usually prevents the utilization of formal healthcare, where some individuals may opt for alternative sources of care such as traditional healers.

Challenge #5: Several structural barriers prevent people with PDNI from accessing preventive, promotive, curative, and rehabilitation care.

• There is still a lack of disability mainstreaming in that the infrastructural design of the healthcare facilities, the sanitary facilities, and the public transport systems lack reasonable accommodations to support accessibility for people with PDNI.