Equitable access to quality trauma systems in Low and Middle Income Countries

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Equitable access to quality trauma systems in Low and Middle Income Countries


JournalBMJ Global Health
Article typeJournal research article – Clinical research
Publication date – May – 2022
Authors – Odland Maria Lisa, Abdul-Latif Abdul-Malik, Ignatowicz Agnieszka, Alyande Barnabas, Ofori Bernard Appia, Balanikas Evangelos, Bekele Abebe, Belli Tony, Chu Kathryn M, Ferreira Karen, Howard Anthony, Nzasabimana Pascal, Owolabi Eyitayo O., Nyamathe Samukelisiwe, Kunfah Sheba Mary Pognaa, Tabriri Stephen, Yakubu Mustapha, Whitaker John,Byiringiro Jean Claude, Davies Justine
KeywordsGhana, healthcare facilities, Injury care, low-income and middleincome countries, Rwanda, South Africa
Open access – Yes
SpecialityHealth policy, Trauma surgery
World region Central Africa, Southern Africa, Western Africa
Country: Ghana, Rwanda, South Africa
Language – English
Submitted to the One Surgery Index on May 15, 2022 at 2:19 am
Abstract:

Injuries in low-income and middle-income countries are prevalent and their number is expected to increase. Death and disability after injury can be reduced if people reach healthcare facilities in a timely manner. Knowledge of barriers to access to quality injury care is necessary to intervene to improve outcomes. We combined a four-delay framework with WHO Building Blocks and Institution of Medicine Quality Outcomes Frameworks to describe barriers to trauma care in three countries in sub-Saharan Africa: Ghana, South Africa and Rwanda. We used a parallel convergent mixed-methods research design, integrating the results to enable a holistic analysis of the barriers to access to quality injury care. Data were collected using surveys of patient experiences of injury care, interviews and focus group discussions with patients and community leaders, and a survey of policy-makers and healthcare leaders on the governance context for injury care. We identified 121 barriers across all three countries. Of these, 31 (25.6%) were shared across countries. More than half (18/31, 58%) were predominantly related to delay 3 (‘Delays to receiving quality care’). The majority of the barriers were captured using just one of the multiple methods, emphasising the need to use multiple methods to identify all barriers. Given there are many barriers to access to quality care for peoplewho have been injured in Rwanda, Ghana and South Africa, but few of these are shared across countries, solutions to overcome these barriers may also be contextually dependent. This suggests the need for rigorous assessments of contexts using multiple data collection methods before developing interventions to improve access to quality care

OSI Number – 21596

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