Health Services Accessibility; Humans; Quality of Health Care; Referral and Consultation; Rwanda; Stakeholder Participation; Trauma Centers; Wounds and Injuries/therapy; Wounds and Injuries; Surgery
Abstract :
[en] ("[en] BACKGROUND: Whilst 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.
METHODS: A 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.
RESULTS: Initially, 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.
CONCLUSION: Overcoming 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.","[en] ","")
Disciplines :
Public health, health care sciences & services
Author, co-author :
Odland, Maria Lisa; Institute of Applied Health Research, University of Birmingham, Birmingham, UK
Whitaker, John ; Faculty 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, London, SE5 9RJ, UK. John.K.Whitaker@kcl.ac.uk ; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK. John.K.Whitaker@kcl.ac.uk
Nepogodiev, Dmitri; National Institute for Health Research, Global Health Research Unit on Global Surgery, Institute of Translational Medicine, University of Birmingham, Birmingham, UK
Aling', Carolyn Achieng'; King Faisal Hospital, Kigali, Rwanda
Bagahirwa, Irene; Rwanda Biomedical Centre, Kigali, Rwanda
Dushime, Theophile; SAMU Division, Ministry of Health, Kigali, Rwanda
Erlangga, Darius; Warwick Medical School, Population Evidence and Technologies, University of Warwick, Coventry, UK
Mpirimbanyi, Christophe; University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
Muneza, Severien; University Teaching Hospital of Kigali, Kigali, Rwanda
Nkeshimana, Menelas; University Teaching Hospital of Kigali, Kigali, Rwanda
Nyundo, Martin ; Université de Liège - ULiège > Faculté de Médecine > Form. doct. sc. méd. (paysage) ; University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda ; University Teaching Hospital of Kigali, Kigali, Rwanda
Umuhoza, Christian; University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
Uwitonze, Eric; SAMU Division, Ministry of Health, Kigali, Rwanda
Steans, Jill; Department of Political Science and International Studies, School of Government and Society, University of Birmingham, Birmingham, UK
Rushton, Alison; School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
Belli, Antonio; College of Medicine and Dental Sciences, NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK
Byiringiro, Jean Claude; University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda ; University Teaching Hospital of Kigali, Kigali, Rwanda
Bekele, Abebe; University of Global Health Equity, Kigali, Rwanda
Davies, Justine; Institute of Applied Health Research, University of Birmingham, Birmingham, UK ; Faculty 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, London, SE5 9RJ, UK ; Faculty of Health Sciences, Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, University of Witwatersrand, Johannesburg, Gauteng, South Africa
University of Birmingham’s Institute for Global Innovation.
Funding text :
Funding for the project was received from The University of Birmingham’s Institute for Global Innovation. Prof Belli is funded by the National Institute for Health Research (NIHR) Surgical Reconstruction and Microbiology Research Centre (SRMRC). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.Antonio Belli is funded by the National Institute for Health Research (NIHR) Surgical Reconstruction and Microbiology Research Centre (SRMRC). All other authors declare no conflict of interest.
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