Prioritising and mapping barriers to achieve equitable surgical care in South Africa: a multi-disciplinary stakeholder workshop
Date
2022-04-14
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Abstract
Background: Surgical healthcare in South Africa is inequitable with a considerable lack of
resources in the public health sector. Identifying barriers to care and creating research
priorities to mitigate these barriers can contribute to strategic interventions to improve
equitable access to quality surgical care.
Objective: To use the Four Delays Framework to map barriers to surgical care and identify
priorities to achieve equitable and timely access to quality surgical care in South Africa.
Methods: A multi-disciplinary stakeholder workshop was held in Cape Town, South Africa in
January 2020. A Four Delays Framework (delays in seeking care, reaching care, receiving care,
and remaining in care) was used to identify barriers that occur at each delay and the top 10
priorities for intervention. Barriers were categorised into overarching themes and schematically mapped.
Results: Thirty-four stakeholders including health service users, health service providers, and
community members participated in this exercise. In total, 34 barriers were identified with 73
connections to various delays. Specifically, 14 barriers were related to delays in seeking care,
11 were related to delays in reaching care, 20 were related to delays in receiving care, and 28
were related to delays in remaining in care. The highest priority barriers across the delays
were Lack of service provider’s knowledge, training and experience, and Limited surgical outreach. The barrier Lack of decentralised services was related to all four delays. Barriers were
interconnected and potentially reinforcing.
Conclusions: This workshop is the first of its kind to generate evidence on the delays to
surgical care in South Africa. Mapping crucial interconnected, potentially reinforcing barriers,
and priority interventions demonstrated how a multifaceted approach may be required to
address delays to access. Further research focused on the identified priorities will contribute
to efforts to promote equitable access to quality surgical care in South Africa.
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Keywords
Barriers to care; priority setting; surgery; health systems; South Africa