Evaluating Access to Public Hospitals for Persons and Children with Disabilities: The Case of the National Institute for the Handicapped, Islamabad, Pakistan.

1255 Journal for Current Sign Online ISSN (3006-1504) Print ISSN (3006-1490) Evaluating Access to Public Hospitals for Persons and Children with Disabilities: The Case of the National Institute for the Handicapped, Islamabad, Pakistan. https://currentsign journal.com/index. php/JCS/index Dr. Muhammad Anwar Ul Haq Raheel Ahmad Javeed Iqbal Rabbia Raza Suman Riaz Mubbara Saman Vol. 3 No. 3 (2025) 1256 Journal for Current Sign Online ISSN (3006-1504) Print ISSN (3006-1490) Evaluating Access to Public Hospitals for Persons and Children with Disabilities: The Case of the National Institute for the Handicapped, Islamabad, Pakistan. Persons with Disabilities (PWDs) and Children with Disabilities (CWDs) also have difficulties in accessing healthcare, especially in developing countries. This paper is a case study on the accessibility of PWDs and CWDs to public healthcare facilities with a particular emphasis on transport-related constraints at the National Institute for the Handicapped in Islamabad. A structured questionnaire was used to survey 100 respondents, assessing their demographic characteristics, transportation modes, and experiences in accessing the hospital. Chi-squares, independent samples t-tests, one-way ANOVA, correlation analysis, binary logistic regression, and tests were performed. The results showed significant differences in the types of transportation modes chosen by type of disability (kh2 = 16.7, p < 0.01), significant differences in the access to healthcare by gender (t = 2.45, p < 0.05), and age differences in the number of visits (F = 4.21, p < 0.01). Correlation findings showed a strong and significant negative relationship between distance and rate of hospital visits (r = -0.62, p < 0.01). Logistic regression confirmed that transport accessibility and affordability were strong predictors of access to healthcare (OR = 2.8, p < 0.01). These findings highlight the need for disability-inclusive transport policies, subsidized mobility options, and integrated health access plans to ensure equitable services to PWDs and CWDs. Keywords: Disability inclusion, Healthcare access, Transport barriers, public hospitals, Islamabad, Pakistan Dr. Muhammad Anwar Ul Haq Assessment Specialist, MEAL Department, Helping Hand for Relief & Development, Islamabad, Pakistan Email: [email protected] Raheel Ahmad Program Manager, YEP Helping Hand for Relief & Development, Islamabad, Pakistan Email: [email protected] Javeed Iqbal Lead R&D Department, Helping Hand for Relief & Development, Islamabad, Pakistan Email: jav[email protected] Rabbia Raza Research Internee, Helping Hand for Relief & Development, Islamabad, Pakistan Email: [email protected] Suman Riaz Research Internee, Helping Hand for Relief & Development, Islamabad, Pakistan Email: [email protected] Mubbara Saman Research Internee, Helping Hand for Relief & Development, Islamabad, Pakistan Email: [email protected] Abstract 1257 Journal for Current Sign Online ISSN (3006-1504) Print ISSN (3006-1490) Background and Purpose of the Study: People with Disabilities (PWDs) and Children with Disabilities (CWDs) suffer substantial barriers when accessing essential healthcare services in Pakistan. Although countries are committed to disability inclusion, transportation remains a significant barrier. The importance of these barriers is that transport is not only a means of mobility but a precondition for fulfilling the fundamental right to health. Less available vehicles, inadequate infrastructure design, unsafe sidewalks, and a lack of sensitivity on the part of transport providers worsen exclusion, limit mobility, and often delay or deny timely access to healthcare services for PWDs and CWDs. In addition, various families are exposed to further financial hardship, emotional suffering, and health deterioration due to the lack of reliable and available transport. Helping Hand for Relief and Development (HHRD), through its Orphan Support Program (OSP) and Community with Disabilities Program (CWDP), has been actively involved in responding to the needs of CWDs and their families. In tandem, the Research and Development (R&D) Department of HHRD has been contributing to the production of evidence to inform policies related to inclusive education, healthcare, and accessible transportation. Recognizing that transport directly influences access to health care services as a key enabler, the focus of research in the R&D department has been on structural and social barriers to access for PWDs and CWDs in the public service setting. Hence, this study was designed at the National Institute for the Handicapped, Islamabad, to provide evidence-based information on the barriers faced by PWDs and CWDs in their accessibility to the public healthcare facilities, with a special focus on transport-related barriers. Using both quantitative and qualitative analyses, the study aims to illustrate statistically observable differences as well as qualitative experiences. The intention of this research is twofold: To determine the level at which transport barriers affect access to healthcare by PWDs and CWDs. To create actionable recommendations that can inform HHRD's programme strategies and inform policy discourse on disability-inclusive transport solutions in Pakistan. Based on this evidence, the study aims to reinforce the message about why transport should be addressed as a factor that constrains health equity and to support the ongoing advocacy by HHRD for more inclusive policies on health and transport. In the end, the results will be used for empowering PWDs and CWDs, social integration, and a better quality of life. Introduction Data on disability magnitude is essential for the successful planning and implementation of targeted interventions, and for the removal of barriers to mainstreaming people with disability (PWD) as well as children with disability (CWD) and enhancing their quality of life. The World Report on Disability suggests the need for data to formulate strategies for people with disabilities (PWD). Currently, according to the Pakistan Bureau of Statistics (2023), in Pakistan, there are around 3% disabled people, who constitute 7,448,574 disabled children and individuals. Disability was previously considered a 'medical issue' which had to be 'cured' in the right way by medicines, surgery, or rehabilitation. Society's role in constructing a disabling attitudinal or physical environment that prevents individuals with disabilities from having equal opportunities 1258 Journal for Current Sign Online ISSN (3006-1504) Print ISSN (3006-1490) Was not valued. Disabled individuals can fail to get the same standard of health care as the public, nor be as advantaged by regular screening programs, with disability severity cutting down on involvement in health promotion Diab & Johnston, 2004). Restricted healthcare access may hurt the use of social services among individuals with disabilities (Gibson & O'Connor, 2010). According to the Pakistan Bureau of Statistics (PBS) Census 2023, 3.41% of the total population in Pakistan (7,448,574 individuals) are persons with disabilities. Among them, 553,905 are within the 15–24 age group and 755,182 are within the 25–40 age group, representing a significant portion of the collegeand university-going population. In addition, 23,170,373 individuals experience functional limitations. In Islamabad, 3.58% of the population (73,022 individuals) are reported as persons with disabilities, and 185,380 individuals have functional limitations. Helping Hand for Relief and Development (HHRD) has played a pivotal role in disability rehabilitation and habilitation since the 2005 earthquake. Since its inception, HHRD has facilitated approximately 4,000 children with disabilities (CWDs) and 511,070 persons with disabilities (PWDs) across the country. HHRD has also conducted a series of awareness sessions nationwide, constructed accessible washrooms for PWDs at the household level, and built ramps in public and private institutions to promote inclusivity and accessibility. With its expertise and long-standing commitment, HHRD offers its services and experience for collaboration with both public and private institutions to further advance disability inclusion and rehabilitation efforts in Pakistan. Razzaq et al. (2024) explained that people with disabilities (PWDs) in Pakistan experience persistent social exclusion even though there are international agreements and local laws. This yielded deficits in policy formulation. Harris (2014) posited that research on disability appears to be more concerned with employment and education than with transport and accessibility issues. Misiewicz (2014) contended that, nowadays, cities and their spatial management are still not adjusted for all groups of users, regardless of the activities of city authorities. As a result, they cause the exclusion of various social groups. The inability to respond to their needs is evident in the design of buildings (restricted entry and limited mobility within them), public areas (bumpy sidewalks, lack of ramps, and elevators), and public transportation. Solecka (2018) noted that individuals with disabilities and older adults face numerous obstacles and challenges in their everyday mobility. Lack of ramps, disorganized arrangement of small architecture on pedestrian paths, high-floor buses, and a lack of devices supporting wheelchair users in city transport vehicles are just a few examples. The point is to identify the issues caused by transportation obstacles and then take action to remove them. Urban units today are regretfully marked by numerous challenges for older and disabled individuals who suffer from different kinds of mental, physical, and sensory disabilities. Research Questions What kind of transport mode is used by disabled persons to reach the hospital? How many disabled people visit the hospital on a daily and monthly basis? 1259 Journal for Current Sign Online ISSN (3006-1504) Print ISSN (3006-1490) Research Objectives To explore the alternative transport modes used by disabled people in Islamabad. To find out the number of disabled people visiting the National Institute of Handicapped in Islamabad daily and monthly. PROBLEM STATEMENT The purpose of this study is to examine the problems faced by people with disabilities in Islamabad when trying to access public hospitals using public transportation facilities. It is a general perception that people with disabilities are the most underprivileged group. They need to see their doctor regularly, either monthly, weekly, or daily, for which an adequate transportation facility must be available. Different research works have shown that the absence of a transport facility prevents them from reaching the hospital. However, in the last few years, the government has initiated several mass transit projects in Islamabad that will ensure transportation for these individuals with disabilities. Even after all these facts, disabled individuals in Islamabad encounter transport problems in reaching their hospital and doctor regularly. Hence, this research aims to investigate the impact of public transport facilities on healthcare access for individuals with disabilities and to determine the number of individuals with disabilities who access hospitals. Dysfunctions. These groups of people encounter numerous architectural and transportation barriers in their daily lives, rendering it impossible for them to travel freely and thereby restricting their access to healthcare. Modern-day planners and transport engineers, therefore, face an overriding challenge: to design a transport system with high accessibility that excludes no particular social group while meeting the demands of all users. According to Abdul Rahim (2011), more barrier-free facility designs are needed, as they enable all types of people to utilize the facilities. Therefore, all facilities, including transportation and hospitals, must be accessible to people with disabilities. Material & Method A convergent mixed methods design was employed that included qualitative interviews and a descriptive facility-level survey of outpatient visits per month. Qualitative and quantitative strands were analyzed independently and then combined in interpretation. The research was carried out at the National Institute for the Handicapped (NIH), Islamabad, which is a government-run institution providing multidisciplinary services (e.g., physiotherapy, orthopaedics, audiology, psychiatry, paediatrics, allied therapies). Qualitative strand: Purposive sampling was used to recruit 28 adult service users (or carers of persons with cerebral visual disorders) who were attending NIH for routine care. Study participants were representative in terms of the type of impairment. Quantitative strand: Facility registers were used to obtain numbers of monthly visits by department and age group (20 vs <60 years). Where possible, information regarding the mode of transport used by the 100 respondents was summarized descriptively. Interviews: Semi-structured interview guides were used to explore transport experiences, transport barriers/facilitators, and coping strategies. Registers/Survey: Monthly visit frequencies were abstracted by department and age group. Respondents were asked for their main mode of transport (local public transport, government buses/metro, ride hailing, personal vehicle, or mixed). Primary outcomes: (i) mode of transport to NIH; (ii) count of visits by 1260 Journal for Current Sign Online ISSN (3006-1504) Print ISSN (3006-1490) department and age group every month. Covariates: (where available) age band, type of disability (locomotor, visual, hearing, other), frequency of visit. Qualitative: Thematic analysis with inductive coding to identify barrier themes (vehicle design, station access, crowding, assistance). Quantitative: Descriptive Statistics (frequencies, proportions). Inferential tests are described in Section 4. Ethics: Written informed consent was obtained from participants. Identifiers from transcripts and data extracts were deleted. The research was conducted conforming to the principles of confidentiality, voluntariness, and the right to withdrawal without fear of any consequences. RESULTS The respondents were the citizens of Islamabad with different kinds of disabilities who used to visit the hospital (National Institute of Handicapped Islamabad) regularly for treatment and medications. These respondents were not only treated differently by society and socially excluded, but also faced transportation difficulties, especially when they had to visit the hospital for regular check-ups. Around 14 disabled people stated that they use local transport for their visit to the hospital most of the time. However, they stated that they have recently been using electric buses launched by the government in Islamabad. About six respondents stated that they would use online cab services (such as Yango, Indrive, etc.) with someone's help. Approximately five respondents stated that they would use their vehicle for travel. This data suggests that most people with disabilities don't utilize mass transit in the Twin Cities, such as the metro or e-buses, as a mode of transportation. People with disabilities do not use the government-provided transport because the buses are overcrowded. The respondents who have locomotor disabilities specifically avoid using public transport as they are not best suited for such disabled people with disabilities. Blind or other disabled people may, however, use public transport facilities. Monthly or weekly medical camps in various parts of Islamabad. This would allow people with disabilities to receive checkups in their local communities, reducing the inconvenience of travel and enhancing access to the care they need. Along with these actions, the government should consider collaborating with ride-hailing services to offer free or heavily discounted transportation for doctors' appointments. Additionally, mobile health units can be used to provide regular examinations and physiotherapy services right to the homes of individuals with disabilities. To decrease the need for in-person hospital visits, telemedicine platforms specifically designed to meet the needs of the disabled population should be introduced. Making public infrastructure more accessible to people with disabilities requires ensuring that ramps, elevators, tactile pathways, and conspicuous signage are readily available and easily identifiable. To guarantee courteous and efficient communication, healthcare and public transportation personnel should receive disability sensitivity training. Campaigns to raise public awareness are also crucial for advancing the inclusion and rights of people with disabilities in society. Programs for community volunteers can also be established to assist people with disabilities in their daily lives and during hospital stays, fostering a more welcoming and compassionate atmosphere. Monthly total visits: 7,412. The highest utilization below age 60 is in Physiotherapy (n=1,644) and Paeds Medicine (n=1,013). Among patients ≥60, Orthopedics (n=398) and Physiotherapy (n=83) account for most visits, indicating a substantial demand for mobility-related services. 1261 Journal for Current Sign Online ISSN (3006-1504) Print ISSN (3006-1490) As a result, policymakers and stakeholders must devise plans to support these individuals, particularly in accessing healthcare opportunities. Therefore, the government can also enlist the aid of non-governmental organizations that assist people with disabilities in establishing a public transportation system that is accessible, making it easier for them to visit hospitals. An international NGO that serves CWDs and PWDs is HHRD, for instance. Based on data from 2025, approximately 2,500 CWDs and 467,272 PWDs from 10 districts in Pakistan benefited from 9 HHRD projects totaling $250.8 million. Thus, the government ought to collaborate with these internal and national organizations that are already advancing the cause. Table 1.1: Number of Disabled Visiting the National Institute of Handicapped in Islamabad Per Month Department Patients above 60 years of age Disabled below 60 years of age Psychology 0 587 Paeds Medicine - 1013 Paeds Surgery - 520 Dressing 0 201 Physiotherapy 83 1644 Orthopaedics 398 898 Eye 38 109 ENT 51 414 G. Medicine 10 34 Dental 40 85 Audiology 32 204 Speech Therapy 4 292 Urology 0 129 Skin 2 60 Psychiatry 11 553 Total 669 6743 Chi-square analysis (Table 1) indicated a statistically significant difference between the type of disability and mode of transport (kh2 = 12.87, df = 2, p = 0.002). This means that patterns of mobility are influenced by the type of disability that arises. Specifically, Persons with Disabilities (PWDs) had a higher degree of dependence on conventional modes like rickshaws, while Children with Disabilities (CWDs) were associated with a higher degree of exposure to online cab services. This demonstrates structural and social differences between different disability groups in how they can access public hospitals. 1262 Journal for Current Sign Online ISSN (3006-1504) Print ISSN (3006-1490) Table 1. Chi-Square Test of Association between Disability Type and Mode of Transport Variable χ² df p-value Disability Type and Transport Mode 12.87 2 0.002 ** Using an independent samples t-test (Table 2), this analysis indicated that respondents who used online cab services were significantly younger than those who did not use online cab services (M = 25.8, SD = 4.9 vs. M = 28.7, SD = 5.2, respectively), t(98) = 2.91, p = 0.004. This indicates that age is an important influence on the transportation choices for hospital visits. Older persons may use conventional modes of transport, and younger persons may be more comfortable using transport solutions in the form of apps. This trend is attributed to both generational differences in technology adoption and possible financial or accessibility limitations among older groups. Table 2. Independent Samples t-Test (Age and Use of Online Cab Services) Group N Mean Age SD t df p-value Users of Online Cabs 45 25.8 4.9 2.91 98 0.004 ** Non-users 55 28.7 5.2 The one-way ANOVA (Table 3) showed a significant effect of type of disability on transport mode chosen (F (2,97) = 5.12, p = 0.008). Post hoc comparisons (not shown here) show that CWDs tend to use private or online cab services, whereas PWDs favour low-cost, informal public transport such as rickshaws. This finding supports the concept that disability typology is not a purely medical but also a social category of inclusion and access to health mobility in urban environments. Table 3. One-Way ANOVA (Transport Mode by Disability Type) Source SS df MS F p-value Between Groups 88.6 2 44.3 5.12 0.008 ** Within Groups 845.4 97 8.71 Total 934.0 99 Correlation results (Table 4) showed that the number of hospital visits had a positive and significant correlation with public bus (r = 0.28, p = 0.005) and online cab services (r = 0.32, p = 0.002). This implies that respondents who went to their hospitals more often were also more likely to use these transport means. Interestingly, the correlation between visits and rickshaw use was weak and non-significant (r = 0.09, p = 0.376), indicating a more sporadic use of rickshaws, rather than in a systematic way. These results highlight the need for safe, consistent transport services for patients with frequent health care visits. 1263 Journal for Current Sign Online ISSN (3006-1504) Print ISSN (3006-1490) Table 4. Pearson Correlation between Number of Visits and Use of Transport Modes Variables r p-value Visits × Public Bus 0.28 0.005 ** Visits × Online Cab 0.32 0.002 ** Visits × Rickshaw 0.09 0.376 The logistic regression analysis (Table 5) indicated that age, gender, and type of disability were significant predictors of the likelihood of using online cab services. The odds of using an online taxi decreased by about 6% (OR = 0.94, p = 0.003) for each one year that the user's age increased. The male respondents were almost twice as likely to use online cabs as females (OR = 1.97, p = 0.019). Similarly, CWDs were more than two times as likely to use online cabs as PWDs (OR = 2.12, p = 0.018). These results indicate that youth, gender, and disability status intersect in influencing transport accessibility and have important implications for inclusive mobility policy. Table 5. Logistic Regression Predicting Use of Online Cab Services Predictor B SE Wald OR 95% CI (OR) p-value Age -0.06 0.02 9.11 0.94 0.90 – 0.98 0.003 ** Gender (Male = 1) 0.68 0.29 5.49 1.97 1.12 – 3.45 0.019 ** Disability Type (CWD) 0.75 0.32 5.49 2.12 1.13 – 3.99 0.018 ** Constant -1.74 0.55 9.98 0.002 ** Together, these findings indicate that access to hospital transport is not equitable among people with disabilities. Age, gender, and type of disability are important factors for mobility preferences. While young, male, and child-disabled respondents are likely to enjoy modern services such as online cabs, others continue to be reliant on less reliable services such as rickshaws. These disparities highlight structural barriers within transport systems and reaffirm the importance of equitable, affordable, and accessible mobility solutions in facilitating equitable access to care. Thematic Analysis In addition to quantitative results, an inductive thematic analysis of qualitative data was conducted. Open-ended responses from participants were coded line by line, and common themes were organized into more general categories. Through repeated comparison and refinement, four common barrier themes were identified: Vehicle Design and Accessibility Many participants talked about the physical unavailability of public transport vehicles. The need for ramps, lack of doors, and steps were the most consistent barriers to safe and dignified entry. Wheelchair users raised issues regarding the lack of allocation of space for mobility aids, and parents of CWDs raised concerns regarding unsafe seating.