Equitable access to quality trauma systems in low-income and middle-income countries: assessing gaps and developing priorities in Ghana, Rwanda and South Africa

Equi-Trauma Collaborative; Maria Lisa Odland^{1

2

3}, Abdul-Malik Abdul-Latif^{4

5}, Agnieszka Ignatowicz⁴, Barnabas Alayande^{6

7}, Bernard Appia Ofori⁸, Evangelos Balanikas⁹, Abebe Bekele^{10

11}, Antonio Belli^{9

12}, Kathryn Chu^{13

14}, Karen Ferreira¹³, Anthony Howard^{15

16}, Pascal Nzasabimana¹⁷, Eyitayo O Owolabi¹³, Samukelisiwe Nyamathe¹³, Sheba Mary Pognaa Kunfah¹⁸, Stephen Tabiri^{8

18

19}, Mustapha Yakubu^{19

20}, John Whitaker^{4

21}, Jean Claude Byiringiro^{17

22}, Justine I Davies^{4

13

23}

Affiliations

¹ Institute of Applied Health Research, University of Birmingham, Birmingham, UK m.l.odland@bham.ac.uk.
² Department of Obstetrics and Gynecology, St. Olavs University Hospital, Trondheim, Norway.
³ Malawi-Liverpool-Wellcome Trust Research Institute, Blantyre, Malawi.
⁴ Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
⁵ Volta Regional Health Directorate, Ghana Health Service, Accra, Greater Accra, Ghana.
⁶ Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda.
⁷ Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.
⁸ Ghana HUB of NIHR Global Surgery, Tamale, Ghana.
⁹ University of Birmingham, Birmingham, UK.
¹⁰ University of Global Health Equity, Kigali, Rwanda.
¹¹ Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia.
¹² National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Birmingham, UK.
¹³ Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa.
¹⁴ Department of Surgery, University of Botswana, Gaborone, Botswana.
¹⁵ Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds, Leeds, UK.
¹⁶ Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, National Institute of Health Research (NIHR) Biomedical Centre, University of Oxford, Headington, Oxford, UK.
¹⁷ University of Rwanda, Kigali, Rwanda.
¹⁸ Department of Public Health, Tamale Teaching Hospital, Tamale, Ghana.
¹⁹ Department of Surgery, Tamale Teaching Hospital, Tamale, Ghana.
²⁰ School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana.
²¹ King's Centre for Global Health and Health Partnerships, King's College London Faculty of Life Sciences and Medicine, London, UK.
²² Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda.
²³ Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.

PMID: 35410954
PMCID: PMC9003614
DOI: 10.1136/bmjgh-2021-008256

Equitable access to quality trauma systems in low-income and middle-income countries: assessing gaps and developing priorities in Ghana, Rwanda and South Africa

Equi-Trauma Collaborative et al. BMJ Glob Health. 2022 Apr.

. 2022 Apr;7(4):e008256.

doi: 10.1136/bmjgh-2021-008256.

Authors

Affiliations

¹ Institute of Applied Health Research, University of Birmingham, Birmingham, UK m.l.odland@bham.ac.uk.
² Department of Obstetrics and Gynecology, St. Olavs University Hospital, Trondheim, Norway.
³ Malawi-Liverpool-Wellcome Trust Research Institute, Blantyre, Malawi.
⁴ Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
⁵ Volta Regional Health Directorate, Ghana Health Service, Accra, Greater Accra, Ghana.
⁶ Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda.
⁷ Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.
⁸ Ghana HUB of NIHR Global Surgery, Tamale, Ghana.
⁹ University of Birmingham, Birmingham, UK.
¹⁰ University of Global Health Equity, Kigali, Rwanda.
¹¹ Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia.
¹² National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, Birmingham, UK.
¹³ Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa.
¹⁴ Department of Surgery, University of Botswana, Gaborone, Botswana.
¹⁵ Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds, Leeds, UK.
¹⁶ Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, National Institute of Health Research (NIHR) Biomedical Centre, University of Oxford, Headington, Oxford, UK.
¹⁷ University of Rwanda, Kigali, Rwanda.
¹⁸ Department of Public Health, Tamale Teaching Hospital, Tamale, Ghana.
¹⁹ Department of Surgery, Tamale Teaching Hospital, Tamale, Ghana.
²⁰ School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana.
²¹ King's Centre for Global Health and Health Partnerships, King's College London Faculty of Life Sciences and Medicine, London, UK.
²² Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda.
²³ Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.

PMID: 35410954
PMCID: PMC9003614
DOI: 10.1136/bmjgh-2021-008256

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.

Keywords: Health policy; Health services research; Health systems; Health systems evaluation; Traumatology.

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Conflict of interest statement

Competing interests: None declared.

Figures

**Figure 1**
Number of consensus barriers in each delay and overlapping delays.

See this image and copyright information in PMC

References

1. Gosselin RA, Spiegel DA, Coughlin R, et al. . Injuries: the neglected burden in developing countries. Bull World Health Organ 2009;87:246–46a. 10.2471/BLT.08.052290 - DOI - PMC - PubMed
1. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 2006;3:e442. 10.1371/journal.pmed.0030442 - DOI - PMC - PubMed
1. United Nations . Global indicator framework for the sustainable development goals and targets of the 2030 agenda for sustainable development. Available: https://unstats.un.org/sdgs/indicators/Global%20Indicator%20Framework%20... [Accessed 8 Jul 2021].
1. Meara JG, Greenberg SLM. The Lancet Commission on global surgery global surgery 2030: evidence and solutions for achieving health, welfare and economic development. Surgery 2015;157:834–5. 10.1016/j.surg.2015.02.009 - DOI - PubMed
1. Rogers FB, Rittenhouse KJ, Gross BW. The golden hour in trauma: dogma or medical folklore? Injury 2015;46:525–7. 10.1016/j.injury.2014.08.043 - DOI - PubMed

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Equitable access to quality trauma systems in low-income and middle-income countries: assessing gaps and developing priorities in Ghana, Rwanda and South Africa

Affiliations

Equitable access to quality trauma systems in low-income and middle-income countries: assessing gaps and developing priorities in Ghana, Rwanda and South Africa

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources