People with disabilities: the case of primary health care in chile

Valdebenito, Francisca; Hasbún, Julio; García, Javier; Marchant, Michell; San, Lisbet; Flores, Hans (2018). 'People with disabilities: the case of Primary Health Care in Chile' Paper presented at the annual conference of the HDCA, Buenos Aires, Argentina 2018.


Cities offer facilitators or barriers to disabled people for exercising their autonomy. Design and state of cities are determinant for establishing a deployment degree on average which disabled population may have in public spaces.

In this way, it is important to ask about offered possibilities to disabled people in Latin America cities to access to first order benefits, such as Atención Primaria de Salud (Health Primary Care) services.

This research shows the routes done by 17 disabled people which are users of Atención Primaria de Salud (Health Primary Care), when they must attend to control checks.
Three centres were studied in a gradient by urbanization level, starting from Estación Central (Santiago de Chile), going through Iquique (regional capital), ending in an urban commune with rural population, such as Empedrado.

In these three centres, “walking interviews” were carried out, in which users were accompanied from the exit of their places to the end of the health attendance, being able to identify aspects as moods, emotions and difficulties during the route.

The previous record was complemented applying a poll to the workers of each centre (N = 200). Specifically, it was used the Attitudes Towards Disabled Persons (ATDP) instrument, in its O form (Yuker, Block y Younng: 1970).

The results of the “walking interview” allow to reveal that approaching experience and access to the centres of Atención Primaria de Salud (Health Primary Care) show difficulties in every step of the route: streets, public transport, access boards, attention areas, medical appointing, and bathrooms. Disabled people’s experience is between morning optimism and dissatisfaction and frustration by fatigue and difficulties through the route.

In another way, the poll shows workers perceive disabled people who are attended in centres as: hard-to-treat people, more irritable, and you have to be careful in what you say to them.
When triangulating the analysis, it is observed a conflict on the attention process received by disabled people because, in one hand, on route barriers are not shown to workers and, in another hand, disabled people have less tolerance to long wait times of health centres.

The previous dynamic shows the relationship between barriers of city surroundings, and negative perceptions of workers about disabled people, because these perceptions are due to the invisibility of barriers offered by the city in disabled people’s experience.

Additionally, the research shows evidence related to small cities in Chile, with less resources, that are experimented as the most inclusive by disabled people, and workers’ perceptions related to these are more favourable than their big city’s colleagues.

It is reflected about social construct of disability, which is wrongly informed by impressions that do not considerate difficulties of urban contexts shown to disabled people.

So, physical barriers are transformed into attitudinal and social barriers, decreasing action autonomy and capacity of these people.

Finally, work points are identified for Atención Primaria de Salud (Health Primary Care) teams, in which the integration of action means is not just on an internal level, as health services provider institutions, but more consistently in a re-comprension of disability inhabiting a space and environment dissimilar to its necessities, and does not facilitate the full exercising of its diary activities.

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