Identifying, Prioritizing and Visually Mapping Barriers to Injury Care in Rwanda: A Multi‐disciplinary Stakeholder Exercise

World Journal of Surgery - Tập 44 Số 9 - Trang 2903-2918 - 2020
Maria Lisa Odland1, John K. Whitaker2,3, Dmitri Nepogodiev4, Carolyn Achieng’ Aling’5, Irene Bagahirwa6, Theophile Dushime7, Darius Erlangga8, Christophe Mpirimbanyi9, Sévérien Muneza10, Menelas Nkeshimana10, Martin Nyundo10,9, Christian Umuhoza9, Eric Uwitonze7, Jill Steans11, A. Rushton12, Antonio Belli13, Jean Claude Byiringiro10,9, Abebe Bekele14, Justine Davies15,3
1Institute of Applied Health Research, University of Birmingham, Birmingham, UK
2Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
3Faculty of Life Sciences and Medicine, King's Centre for Global Health and Health Partnerships King's College London Room 2.13, Global Health Offices, Weston Education Centre, Cutcombe Road SE5 9RJ London UK
4National Institute for Health Research, Global Health Research Unit on Global Surgery, Institute of Translational Medicine, University of Birmingham, Birmingham, UK
5King Faisal Hospital, Kigali, Rwanda
6Rwanda Biomedical centre, Kigali, Rwanda
7SAMU Division, Ministry of Health, Kigali, Rwanda
8Warwick Medical School, Population Evidence and Technologies, University of Warwick, Coventry, UK
9University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda
10University Teaching Hospital of Kigali, Kigali, Rwanda
11Department of Political Science and International Studies, School of Government and Society, University of Birmingham, Birmingham, UK
12School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
13College of Medicine and Dental Sciences, NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
14University of Global Health Equity, Kigali, Rwanda
15Faculty of Health Sciences, Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, University of Witwatersrand, Johannesburg, Gauteng, South Africa

Tóm tắt

AbstractBackgroundWhilst injuries are a major cause of disability and death worldwide, a large proportion of people in low‐ and middle‐income countries lack timely access to injury care. Barriers to accessing care from the point of injury to return to function have not been delineated.MethodsA two‐day workshop was held in Kigali, Rwanda in May 2019 with representation from health providers, academia, and government. A four delays model (delays to seeking, reaching, receiving, and remaining in care) was applied to injury care. Participants identified barriers at each delay and graded, through consensus, their relative importance. Following an iterative voting process, the four highest priority barriers were identified. Based on workshop findings and a scoping review, a map was created to visually represent injury care access as a complex health‐system problem.ResultsInitially, 42 barriers were identified by the 34 participants. 19 barriers across all four delays were assigned high priority; highest‐priority barriers were “Training and retention of specialist staff”, “Health education/awareness of injury severity”, “Geographical coverage of referral trauma centres”, and “Lack of protocol for bypass to referral centres”. The literature review identified evidence relating to 14 of 19 high‐priority barriers. Most barriers were mapped to more than one of the four delays, visually represented in a complex health‐system map.ConclusionOvercoming barriers to ensure access to quality injury care requires a multifaceted approach which considers the whole patient journey from injury to rehabilitation. Our results can guide researchers and policymakers planning future interventions.

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World Journal of Surgery

Tập 44 Số 9

2903-2918

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