7 research outputs found
Barriers to equitable access to quality trauma care in Rwanda:a qualitative study
No full textObjectives Using the ‘Four Delay’ framework, our study aimed to identify and explore barriers to accessing quality injury care from the injured patients’, caregivers’ and community leaders’ perspectives.Design A qualitative study assessing barriers to trauma care comprising 20 in-depth semistructured interviews and 4 focus group discussions was conducted. The data were analysed thematically.Setting This qualitative study was conducted in Rwanda’s rural Burera District, located in the Northern Province, and in Kigali City, the country’s urban capital, to capture both the rural and urban population’s experiences of being injured.Participants Purposively selected participants were individuals from urban and rural communities who had accessed injury care in the previous 6 months or cared for the injured people, and community leaders. Fifty-one participants, 13 females and 38 males ranging from 21 to 68 years of age participated in interviews and focus group discussions. Thirty-six (71%) were former trauma patients with a wide range of injuries including fractured long bones (9, 45%), other fractures, head injury, polytrauma (3, 15% each), abdominal trauma (1, 5%), and lacerations (1, 5%), while the rest were caregivers and community leaders.Results Multiple barriers were identified cutting across all levels of the ‘Four Delays’ framework, including barriers to seeking, reaching, receiving and remaining in care. Key barriers mentioned by participants in both interviews and focus group discussions were: lack of community health insurance, limited access to ambulances, insufficient number of trauma care specialists and a high volume of trauma patients. The rigid referral process and lack of decentralised rehabilitation services were also identified as significant barriers to accessing quality care for injured patients.Conclusions Future interventions to improve access to injury care in Rwanda must be informed by the identified barriers along the spectrum of care, from the point of injury to receipt of care and rehabilitation
Barriers to equitable access to quality trauma care in Rwanda: a qualitative study
No full textUsing the ‘Four Delay’ framework, our study aimed to identify and explore barriers to accessing quality injury care from the injured patients’, caregivers’ and community leaders’ perspectives.This qualitative study was conducted in Rwanda’s rural Burera District, located in the Northern Province, and in Kigali City, the country’s urban capital, to capture both the rural and urban population’s experiences of being injured. Multiple barriers were identified cutting across all levels of the ‘Four Delays’ framework, including barriers to seeking, reaching, receiving and remaining in care. Key barriers mentioned by participants in both interviews and focus group discussions were: lack of community health insurance, limited access to ambulances, insufficient number of trauma care specialists and a high volume of trauma patients. The rigid referral process and lack of decentralised rehabilitation services were also identified as significant barriers to accessing quality care for injured patients
Commonalities and differences in injured patient experiences of accessing and receiving quality injury care:a qualitative study in three sub-Saharan African countries
No full textObjectives: To understand commonalities and differences in injured patient experiences of accessing and receiving quality injury care across three lower-income and middle-income countries. Design: A qualitative interview study. The interviews were audiorecorded, transcribed and thematically analysed. Setting: Urban and rural settings in Ghana, South Africa and Rwanda. Participants: 59 patients with musculoskeletal injuries. Results: We found five common barriers and six common facilitators to injured patient experiences of accessing and receiving high-quality injury care. The barriers encompassed issues such as service and treatment availability, transportation challenges, apathetic care, individual financial scarcity and inadequate health insurance coverage, alongside low health literacy and information provision. Facilitators included effective information giving and informed consent practices, access to health insurance, improved health literacy, empathetic and responsive care, comprehensive multidisciplinary management and discharge planning, as well as both informal and formal transportation options including ambulance services. These barriers and facilitators were prevalent and shared across at least two countries but demonstrated intercountry and intracountry (between urbanity and rurality) variation in thematic frequency. Conclusion: There are universal factors influencing patient experiences of accessing and receiving care, independent of the context or healthcare system. It is important to recognise and understand these barriers and facilitators to inform policy decisions and develop transferable interventions aimed at enhancing the quality of injury care in sub-Saharan African nations
Equitable access to quality trauma systems in low-income and middleincome countries: assessing gaps and developing priorities in Ghana, Rwanda and South Africa
No full textInjuries 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.PM202
Equitable access to quality trauma systems in low-income and middle-income countries: Assessing gaps and developing priorities in Ghana, Rwanda and South Africa
No full textInjuries 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
Health System Governance for Injury Care in Low- and Middle-Income Countries : a survey of policymakers and policy implementors
No full textPeer reviewe
Health system governance for injury care in low- and middle-income countries: a survey of policymakers and policy implementors
No full textIntroduction Good health system governance is essential for reducing high mortality and morbidity after injury in low- and middle-income countries (LMICs). Unfortunately, the current state of governance for injury care is not known. This study evaluated governance for injury care in Ghana, Pakistan, Rwanda and South Africa, four LMICs with diverse contexts, to allow understanding of similarities or difference in the status of governance systems in different LMICs.Method This cross-sectional study captured the perceptions of 220 respondents (31 policymakers and 189 policy implementers) on injury care governance using the framework for governance in health system developed by Siddiqi. Input was captured in 10 domains: strategic vision; participation and consensus; rule of law; transparency; responsiveness; equity and inclusion; effectiveness and efficiency; accountability; intelligence and information; and ethics.Result The median injury care governance score across all domains and countries was 29% (IQR 17–43). The highest median score was achieved in the rule of law (50, 33–67), and the lowest scores were seen in the transparency (0, 0–33), accountability (0, 0–33), and participation and consensus (0, 0–33) domains. Median scores were higher for policymakers (33, 27–48) than for policy implementers (27, 17–42), but the difference was not statistically significant.Conclusion The four studied countries have developed some of the foundations of good injury care governance, although many governance domains require more attention. The gap in awareness between policymakers and policy implementers might reflect a delayed or partial implementation of policies or lack of communication between sectors. Ensuring equitable access to injury care across LMICs requires investment in all domains of good injury care governance
