Equitable access to quality trauma systems in low-income and middleincome countries: assessing gaps and developing priorities in Ghana, Rwanda and South Africa
Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
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 people
who 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.