Barriers to Accessing Multidisciplinary Team Services for Learners with Special Educational Needs and Disabilities at the One Stop Centre of Livingstone University Teaching Hospital, Southern Province of Zambia

Abstract

Children with learning and special educational needs and disabilities (LSEND) require coordinated multidisciplinary services to achieve early identification, timely intervention, and sustainable continuity of care. Although one-stop, co-located multidisciplinary models seek to reduce fragmentation and caregiver burden, evidence from low- and middle-income countries indicates that co-location alone is insufficient unless referral pathways, internal coordination, and follow-up mechanisms are functional. This qualitative descriptive study examined barriers to accessing multidisciplinary team (MDT) services at the One Stop Centre of Livingstone University Teaching Hospital (LUTH), Southern Province, Zambia. Eighteen purposively selected participants were interviewed individually, including 2 nurses, 2 special-education teachers, 2 police officers, 2 caregivers, 2 physiotherapists, 2 psychologists, an occupational therapist, 2 paediatricians, 2 social workers, a psychiatrist, and 2 learners with special educational needs were interviewed with parents present. Interviews were transcribed verbatim and analyzed manually using inductive thematic analysis with two independent coders, consensus meetings, peer debriefing, and member checking. Findings are presented mapped to an operationalized continuum of care entry, internal navigation, intervention capacity, follow-up/referral-out, and post-visit continuity and illustrate how barriers at each stage undermine access and sustained engagement. Key constraints included ineffective referral and low awareness at entry; poor internal coordination and information flow; shortages of trained specialists and equipment limiting intervention capacity; weak follow-up and outbound referral systems; and transport costs, stigma, and caregiver psychological burden that undermine post-visit continuity. The paper concludes with pragmatic, evidence-grounded recommendations to strengthen processes and supports at LUTH so the One Stop Centre can fulfil its potential as an accessible MDT hub for LSEND in Livingstone and Zambia at large.