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Barriers to Essential Surgical Care in Low- and Middle-Income Countries: A Pilot Study of a Comprehensive Assessment Tool in Ghana

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Abstract

Background

Beyond resource deficiencies, other barriers to care prevent patients from receiving surgery in low- and middle-income countries (LMICs). This study aimed to develop and pilot a comprehensive, generalizable tool for assessing the barriers to surgical care.

Methods

Sociodemographic, clinical and 38 questions regarding potential barriers to surgical care were asked during a surgical outreach to two district and one regional hospital in Upper East Region, Ghana. Sites were selected to capture individuals with prolonged unmet surgical needs and represent geographic, socioeconomic, and healthcare development differences. Results were indexed into three dimensions of barriers to care (i.e., ‘acceptability,’ ‘affordability,’ and ‘accessibility’) so that communities could be compared and targeted interventions developed.

Results

The tool was administered to 148 participants (98 % response rate): Bolgatanga 54 (37 %); Amiah 16 (11 %); and Sandema 78 (52 %). Amiah had the fewest barriers to surgical care (median index 8.3; IQR 7.6–9.3), followed by Sandema (8.2; IQR 5.3–9.2) and Bolgatanga (6.7; IQR 3.9–9.5). Individual dimension scores (i.e., acceptability, affordability, accessibility) ranged from 10.8 to 18 out of 18 possible points. Main factors contributing to low dimension scores were different between communities: Bolgatanga—cost and healthcare navigation; Amiah—social marginalization and poor medical understanding; Sandema—distance to surgically capable facility.

Conclusion

This study identified a number of significant barriers, as well as successes for patients’ ability and willingness to access surgical care that differed between communities. The tool itself was well accepted, easy to administer and provided valuable data from which targeted interventions can be developed.

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Acknowledgments

This study was funded in part by ApriDec Medical Outreach Group (AMOG), a Ghanaian-based non-governmental organization, and Grant R25-TW009345 from the Fogarty International Center, US National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors thank the dedicated volunteers of AMOG and hospital staff for their logistical support and Melissa Tosch for her contribution to the development of the assessment tool.

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Authors and Affiliations

  1. Department of Surgery, University of Washington, 1959 NE Pacific St., Suite BB-487, PO Box 356410, Seattle, WA, 98195-6410, USA

    Barclay T. Stewart

  2. Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

    Barclay T. Stewart, Adam Gyedu, Francis Abantanga & Abdul Rashid Abdulai

  3. Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana

    Adam Gyedu & Francis Abantanga

  4. Department of Planning, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

    Godfred Boakye

  5. Surgeons OverSeas (SOS), New York, NY, USA

    Adam Kushner

  6. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Adam Kushner

  7. Department of Surgery, Columbia University, New York, NY, USA

    Adam Kushner

Authors
  1. Barclay T. Stewart
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  2. Adam Gyedu
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  3. Francis Abantanga
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  4. Abdul Rashid Abdulai
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  5. Godfred Boakye
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Correspondence to Barclay T. Stewart.

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Stewart, B.T., Gyedu, A., Abantanga, F. et al. Barriers to Essential Surgical Care in Low- and Middle-Income Countries: A Pilot Study of a Comprehensive Assessment Tool in Ghana. World J Surg 39, 2613–2621 (2015). https://doi.org/10.1007/s00268-015-3168-4

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  • DOI: https://doi.org/10.1007/s00268-015-3168-4

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