How do gender and disability influence the ability of the poor to benefit from pro-poor health financing policies in Kenya? An intersectional analysis²⁰

A qualitative cross-sectional study in Kenya used an intersectional approach to explore how gender, disability and poverty interact to influence if and how women living in/under poverty conditions in Kenya benefit from pro-poor financing policies that target them. In-depth interviews were conducted with women with disabilities living in poverty who were beneficiaries of the health insurance subsidy programme and those in the lowest wealth quintiles residing in the health and demographic surveillance system.

Results: Women with disabilities living in poverty often opted to forgo seeking free health care services because of their roles as the primary household providers and caregivers. Due to limited mobility, they needed someone to accompany them to health facilities, leading to greater transport costs. The absence of someone to accompany them and unaffordability of the high transport costs made some women forgo seeking antenatal and skilled delivery services, for example, despite the existence of a free maternity programme. The layout and equipment at health facilities offering care under pro-poor health financing policies were not disability friendly. In addition, negative health care workers’ attitudes towards women with disabilities discouraged them from seeking care. Negative stereotypes against women with disabilities in the society led to their exclusion from public participation forums, thereby limiting their awareness about health services.

Conclusions: Intersections of gender, poverty and disability influenced the experiences of women with disabilities benefiting from pro-poor health financing policies in Kenya. Addressing the health care access barriers they faced might include ensuring availability of disability-friendly health facilities and public transport systems, building cultural competence in health service delivery, and encouraging the women to engage in public participation.