Table 2.

Overview of themes and subthemes with supporting quotations

Themes	Subthemes	Quotations by participants
Theme 1: Challenges in providing healthcare	1. Limited supplies of drugs and medical equipment	One day a client in a tricycle came to me with leakage of urine. I was thinking of giving him a catheter to manage the problem, but we don’t have some over here.
		We can’t get antibiotics for our clients with disabilities in here because there is a directive from the top…. Because of that clients who need them have to go to health centers or drugstores.
	2. Limited healthcare providers	One day a client with disability came to me with muscle spasm but I was unable to provide treatment to her because I do not have the necessary training to provide such service and also we don’t have any specialist at this level to address the needs of this client.
		For now, we are only two trained nurses that struggle to serve this community and beyond. And so on market days we usually have high workload. This sometimes negatively affects quality healthcare delivery to clients with disabilities.
	3. Financial constraints	Clients with disabilities who come here without health insurance always complained that they are not working and so don’t have money to cover medical expenses and other non-medical things like folder and consultation fees.
		Clients with physical disabilities often postpone visits to healthcare facilities because they don’t have money for transport. They also fear to walk or propel their tricycles far because of the fear of developing more complications.
	4. Inaccessible facilities and equipment	We have weighing scales here, but they are not disability friendly and so when those with severe physical disabilities cannot stand on them we don’t use them when they come for care.
		This facility is not that accessible for those with tricycles because we don’t have ramps at the entrances. The waiting room is also a small space for a tricycle to move freely.
Theme 2: Strategies used in navigating the challenges	1. Improvising techniques and self-sacrifices	For those clients in tricycles when they can’t get into the facility we (providers) usually try to lift the person in. But if we can’t do that we try to put a piece of wood between the gutters for the person to propel the tricycle into the building.
		Some clients with disabilities rely on their family members to come here. Sometimes they have to wait for their family members to return from work or school and if they (ie, family members) come back late, they could also come at the time I’m about to close. When this happens, I have to forgo domestic issues and rather attend to the person’s needs…. This usually happens on market days.
	2. Referring clients	Because we don’t have rehabilitation specialists over here, and so what I usually do is just to refer them to heath facilities that have these specialists.
		We don’t have antibiotics here and as a result I just give them (ie, clients with physical disabilities) referral note to health centers.
	3. Providing financial assistance to clients	I always feel that when clients with physical disabilities come here without money, it is my duty to financially assist them when I can’t get them all the needed care.
		I try to give them (ie, clients with physical disabilities) care and then use my own money to pay for those services because most them can’t afford for the services.
Theme 3: Positive experiences in providing services	1. Feeling rewarded and appreciated in rural practice	I feel happy and proud when I treat clients with disabilities. These clients always feel like neglected in the community and when they come for care they feel happy. Then that I realized how rewarding it is to stay in this community and provide services to them.
		When you provide care to these clients with physical disabilities and you meet them, they are always excited and thank you for the care. And this really makes me happy.
		I was surprised to see a young man who came and gave me some tubers of yams (farm produce) just to express how appreciative he is for the service I provided to his family member with a physical disability.