Identifying, Prioritizing and Visually Mapping Barriers to Injury Care in Rwanda: A Multi-disciplinary Stakeholder Exercise
| Autor: | Abebe Bekele, Theophile Dushime, Justine Davies, Eric Uwitonze, Christian Umuhoza, Severien Muneza, Christophe Mpirimbanyi, Alison Rushton, Darius Erlangga, Irene Bagahirwa, Dmitri Nepogodiev, Jean Claude Byiringiro, Carolyn Achieng’ Aling’, John Whitaker, Menelas Nkeshimana, Maria Lisa Odland, M Nyundo, Jill Steans, Antonio Belli |
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| Rok vydání: | 2020 |
| Předmět: |
Referral
medicine.medical_treatment Psychological intervention Poison control Health Services Accessibility Occupational safety and health Surgery in Low and Middle Income Countries 03 medical and health sciences 0302 clinical medicine Trauma Centers Nursing Stakeholder Participation Injury prevention Humans Medicine 030212 general & internal medicine Referral and Consultation Quality of Health Care Government Rehabilitation business.industry Rwanda 030220 oncology & carcinogenesis Wounds and Injuries Surgery Health education business |
| Zdroj: | World Journal of Surgery |
| ISSN: | 1432-2323 0364-2313 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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