Advertisement

World Journal of Surgery

, Volume 35, Issue 5, pp 941–950 | Cite as

Systematic Review of Barriers to Surgical Care in Low-Income and Middle-Income Countries

  • Caris E. Grimes
  • Kendra G. Bowman
  • Christopher M. Dodgion
  • Christopher B. D. Lavy
Article

Abstract

Background

There is increasing evidence that lack of facilities, equipment, and expertise in district hospitals across many low- and middle-income countries constitutes a major barrier to accessing surgical care. However, what is less clear, is the extent to which people perceive barriers when trying to access surgical care.

Methods

PubMed and EMBASE were searched using key words (“access” and “surgery,” “barrier” and “surgery,” “barrier” and “access”), MeSH headings (“health services availability,” “developing countries,” “rural population”), and the subject heading “health care access.” Articles were included if they were qualitative and applied to illnesses where the treatment is primarily surgical.

Results

Key barriers included difficulty accessing surgical services due to distance, poor roads, and lack of suitable transport; lack of local resources and expertise; direct and indirect costs related to surgical care; and fear of undergoing surgery and anesthesia.

Conclusions

The significance of cultural, financial, and structural barriers pertinent to surgery and their role in wider health care issues are discussed. Immediate action to improve financial and geographic accessibility along with investment in district hospitals is likely to make a significant impact on overcoming access and barrier issues. Further research is needed to identify issues that need to be addressed to close the gap between the care needed and that provided.

Keywords

Supply Chain Cataract District Hospital Emergency Care Obstetric Care 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Debas H, Gosselin R, McCord C et al (2006) Surgery. In: Jamison DT, Breman JG, Measham AR et al (eds) Disease control priorities in developing countries, 2nd edn. Oxford University Press, New YorkGoogle Scholar
  2. 2.
    Weiser TG, Regenbogen SE, Thompson KD et al (2008) An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet 372:90–92CrossRefGoogle Scholar
  3. 3.
    Kushner AL, Cherian MN, Noel L et al (2010) Addressing the millennium development goals from a surgical perspective: essential surgery and anaesthesia in 8 low- and middle-income countries. Arch Surg 145:154–159PubMedCrossRefGoogle Scholar
  4. 4.
    Contini S, Taqdeer A, Cherian MN et al (2010) Emergency and essential surgical services in Afghanistan: still a missing challenge. World J Surg 34:473–479PubMedCrossRefGoogle Scholar
  5. 5.
    Kingham TP, Kamara TB, Cherian MN et al (2009) Quantifying surgical capacity in Sierra Leone: a guide for improving surgical care. Arch Surg 144:122–127PubMedCrossRefGoogle Scholar
  6. 6.
    Funk LM, Weiser TG, Berry WR et al (2010) Global operating theatre distribution and pulse oximetry supply: an estimation from reported data. Lancet 376:1055–1061PubMedCrossRefGoogle Scholar
  7. 7.
    Kruk ME, Wladis A, Mbembati N et al (2010) Human resource and funding constraints for essential surgery in district hospitals in Africa: a retrospective cross-sectional survey. PLoS Med 9:7:e1000242Google Scholar
  8. 8.
    Campbell M, Sahin-Hodoglugil NN, Potts M (2006) Barriers to fertility regulation: a review of the literature. Stud Fam Plann 37:87–98PubMedCrossRefGoogle Scholar
  9. 9.
    Filippi V, Richard F, Lange I (2009) Identifying barriers from home to the appropriate hospital through near-miss audits in developing countries. Best Pract Res Clin Obstet Gynaecol 23:389–400PubMedCrossRefGoogle Scholar
  10. 10.
    Gabrysch S, Campbell OM (2009) Still too far to walk: literature review of the determinants of delivery service use. BMC Pregnancy Childbirth 9:34PubMedCrossRefGoogle Scholar
  11. 11.
    Kiwanuka SN, Ekirapa EK, Peterson S et al (2008) Access to and utilisation of health services for the poor in Uganda: a systematic review of available evidence. Trans R Soc Trop Med Hyg 102:1067–1074PubMedCrossRefGoogle Scholar
  12. 12.
    Lewallen S, Courtright P (2002) Gender and use of cataract surgical services in developing countries. Bull World Health Organ 80:300–303PubMedGoogle Scholar
  13. 13.
    Maslove DM, Mnyusiwalla A, Mills EJ et al (2009) Barriers to the effective treatment and prevention of malaria in Africa: a systematic review of qualitative studies. BMC Int Health Hum Rights 9:26PubMedCrossRefGoogle Scholar
  14. 14.
    Mills E, Jadad AR, Ross C et al (2005) Systematic review of qualitative studies exploring parental beliefs and attitudes toward childhood vaccination identifies common barriers to vaccination. J Clin Epidemiol 58:1081–1088PubMedCrossRefGoogle Scholar
  15. 15.
    O’Donnell O (2007) Access to health care in developing countries: breaking down demand side barriers. Cad Saude Publica 23:2820–2834PubMedGoogle Scholar
  16. 16.
    Ojanuga DN, Gilbert C (1992) Women’s access to health care in developing countries. Soc Sci Med 35:613–617PubMedCrossRefGoogle Scholar
  17. 17.
    Posse M, Meheus F, van Asten H et al (2008) Barriers to access to antiretroviral treatment in developing countries: a review. Trop Med Int Health 13:904–913PubMedCrossRefGoogle Scholar
  18. 18.
    Puentes-Markides C (1992) Women and access to health care. Soc Sci Med 35:619–626PubMedCrossRefGoogle Scholar
  19. 19.
    Ravishankar K (2004) Barriers to headache care in India and efforts to improve the situation. Lancet Neurol 3:564–567PubMedCrossRefGoogle Scholar
  20. 20.
    Rutherford ME, Mulholland K, Hill PC (2010) How access to health care relates to under-five mortality in sub-Saharan Africa: systematic review. Trop Med Int Health 15:508–519PubMedCrossRefGoogle Scholar
  21. 21.
    Say L, Raine R (2007) A systematic review of inequalities in the use of maternal health care in developing countries: examining the scale of the problem and the importance of context. Bull World Health Organ 85:812–819PubMedGoogle Scholar
  22. 22.
    Simkhada B, Teijlingen ER, Porter M et al (2008) Factors affecting the utilization of antenatal care in developing countries: systematic review of the literature. J Adv Nurs 61:244–260PubMedCrossRefGoogle Scholar
  23. 23.
    Thaddeus S, Maine D (1994) Too far to walk: maternal mortality in context. Soc Sci Med 38:1091–1110PubMedCrossRefGoogle Scholar
  24. 24.
    Thomas C (2002) A literature review of the problems of delayed presentation for treatment and non-completion of treatment for tuberculosis in less developed countries and ways of addressing these problems using particular implementations of the DOTS strategy. J Manag Med 16:371–400PubMedCrossRefGoogle Scholar
  25. 25.
    Yorston D (2005) High-volume surgery in developing countries. Eye (Lond) 19:1083–1089CrossRefGoogle Scholar
  26. 26.
    Obrist B, Iteba N, Lengeler C et al (2007) Access to health care in contexts of livelihood insecurity: a framework for analysis and action. PLoS Med 4:1584–1588PubMedCrossRefGoogle Scholar
  27. 27.
    Peters DH, Garg A, Bloom G et al (2008) Poverty and access to health care in developing countries. Ann NY Acad Sci 1136:161–171PubMedCrossRefGoogle Scholar
  28. 28.
    McIntyre D, Thiede M, Birch S (2009) Access as a policy-relevant concept in low- and middle-income countries. Health Econ Policy Law 4(Pt 2):179–193PubMedCrossRefGoogle Scholar
  29. 29.
    Athanasiov PA, Casson RJ, Newland HS et al (2008) Cataract surgical coverage and self-reported barriers to cataract surgery in a rural Myanmar population. Clin Exp Ophthalmol 36:521–525CrossRefGoogle Scholar
  30. 30.
    Briesen S, Geneau R, Roberts H et al (2010) Understanding why patients with cataract refuse free surgery: the influence of rumours in Kenya. Trop Med Int Health 15:534–539PubMedGoogle Scholar
  31. 31.
    Bronsard A, Geneau R, Shirima S et al (2008) Why are children brought late for cataract surgery? Qualitative findings from Tanzania. Ophthalmic Epidemiol 15:383–388PubMedCrossRefGoogle Scholar
  32. 32.
    Chandrashekhar TS, Bhat HV, Pai RP et al (2007) Coverage, utilization and barriers to cataract surgical services in rural South India: results from a population-based study. Public Health 121:130–136PubMedCrossRefGoogle Scholar
  33. 33.
    Geneau R, Lewallen S, Bronsard A et al (2005) The social and family dynamics behind the uptake of cataract surgery: findings from Kilimanjaro region, Tanzania. Br J Ophthalmol 89:1399–1402PubMedCrossRefGoogle Scholar
  34. 34.
    Geneau R, Massae P, Courtright P et al (2008) Using qualitative methods to understand the determinants of patients’ willingness to pay for cataract surgery: a study in Tanzania. Soc Sci Med 66:558–568PubMedCrossRefGoogle Scholar
  35. 35.
    Gyasi M, Amoaku W, Asamany D (2007) Barriers to cataract surgical uptake in the upper east region of Ghana. Ghana Med J 41:167–170PubMedGoogle Scholar
  36. 36.
    Jadoon Z, Shah SP, Bourne R et al (2007) Cataract prevalence, cataract surgical coverage and barriers to uptake of cataract surgical services in Pakistan: the Pakistan National Blindness and Visual Impairment Survey. Br J Ophthalmol 91:1269–1273PubMedCrossRefGoogle Scholar
  37. 37.
    Johnson JG, Goode Sen V, Faal H (1998) Barriers to the uptake of cataract surgery. Trop Doct 28:218–220PubMedGoogle Scholar
  38. 38.
    Kessy JP, Lewallen S (2007) Poverty as a barrier to accessing cataract surgery: a study from Tanzania. Br J Ophthalmol 91:1114–1146PubMedCrossRefGoogle Scholar
  39. 39.
    Mpyet C, Dineen BP, Solomon AW (2005) Cataract surgical coverage and barriers to uptake of cataract surgery in leprosy villages of northeastern Nigeria. Br J Ophthalmol 89:936–938PubMedCrossRefGoogle Scholar
  40. 40.
    Mwende J, Bronsard A, Mosha M et al (2005) Delay in presentation to hospital for surgery for congenital and developmental cataract in Tanzania. Br J Ophthalmol 89:1478–1482PubMedCrossRefGoogle Scholar
  41. 41.
    Ojabo CO, Alao O (2009) Cataract surgery: limitations and barriers in Makurdi, Benue State. Nigerian J Med 18:250–255Google Scholar
  42. 42.
    Rabiu MM (2001) Cataract blindness and barriers to uptake of cataract surgery in a rural community of northern Nigeria. Br J Ophthalmol 85:776–780PubMedCrossRefGoogle Scholar
  43. 43.
    Rotchford AP, Rotchford KM, Mthethwa LP et al (2002) Reasons for poor cataract surgery uptake: a qualitative study in rural South Africa. Trop Med Int Health 7:288–292PubMedCrossRefGoogle Scholar
  44. 44.
    Shrestha MK, Thakur J, Gurung CK et al (2004) Willingness to pay for cataract surgery in Kathmandu valley. Br J Ophthalmol 88:319–320PubMedCrossRefGoogle Scholar
  45. 45.
    Snellingen T, Shrestha BR, Gharti MP et al (1998) Socioeconomic barriers to cataract surgery in Nepal: the South Asian cataract management study. Br J Ophthalmol 82:1424–1428PubMedCrossRefGoogle Scholar
  46. 46.
    Vaidyanathan K, Limburg H, Foster A et al (1999) Changing trends in barriers to cataract surgery in India. Bull World Health Organ 77:104–109PubMedGoogle Scholar
  47. 47.
    Yin Q, Hu A, Liang Y et al (2009) A two-site, population-based study of barriers to cataract surgery in rural China. Invest Ophthalmol Vis Sci 50:1069–1075PubMedCrossRefGoogle Scholar
  48. 48.
    Zhang M, Wu J, Li L et al (2010) Impact of cataract screening outreach in rural China. Invest Ophthalmol Vis Sci 51:110–114PubMedCrossRefGoogle Scholar
  49. 49.
    Amansakhatov S, Volokhovskaya ZP, Afanasyeva AN et al (2002) Cataract blindness in Turkmenistan: results of a national survey. Br J Ophthalmol 86:1207–1210PubMedCrossRefGoogle Scholar
  50. 50.
    Melese M, Alemayehu W, Friedlander E et al (2004) Indirect costs associated with accessing eye care services as a barrier to service use in Ethiopia. Trop Med Int Health 9:426–431PubMedCrossRefGoogle Scholar
  51. 51.
    Lee BW, Sathyan P, John RK et al (2008) Predictors of and barriers associated with poor follow-up in patients with glaucoma in South India. Arch Ophthalmol 126:1448–1454PubMedCrossRefGoogle Scholar
  52. 52.
    Du Toit R, Ramke J, Naduvilath T et al (2006) Awareness and use of eye care services in Fiji. Ophthalmic Epidemiol 13:309–320PubMedCrossRefGoogle Scholar
  53. 53.
    Bowman RJ, Faal H, Jatta B et al (2002) Longitudinal study of trachomatous trichiasis in The Gambia: barriers to acceptance of surgery. Invest Ophthalmol Vis Sci 43:936–940PubMedGoogle Scholar
  54. 54.
    Mahande M, Tharaney M, Kirumbi E et al (2007) Uptake of trichiasis surgical services in Tanzania through two village-based approaches. Br J Ophthalmol 91:139–142PubMedCrossRefGoogle Scholar
  55. 55.
    Nagpal G, Dhaliwal U, Bhatia MS (2006) Barriers to acceptance of intervention among patients with trachomatous trichiasis or entropion presenting to a teaching hospital. Ophthalmic Epidemiol 13:53–58PubMedCrossRefGoogle Scholar
  56. 56.
    Oliva MS, Munoz B, Lynch M et al (1997) Evaluation of barriers to surgical compliance in the treatment of trichiasis. Int Ophthalmol 21:235–241PubMedCrossRefGoogle Scholar
  57. 57.
    Bhuiya A, Aziz A, Chowdhury M (2001) Ordeal of women for induced abortion in a rural area of Bangladesh. J Health Popul Nutr 19:281–290PubMedGoogle Scholar
  58. 58.
    Iyengar K, Iyengar SD, Suhalka V et al (2009) Pregnancy-related deaths in rural Rajasthan, India: exploring causes, context, and care-seeking through verbal autopsy. J Health Popul Nutr 27:293–302PubMedGoogle Scholar
  59. 59.
    Telfer ML, Rowley JT, Walraven GE (2002) Experiences of mothers with antenatal, delivery and postpartum care in rural Gambia. Afr J Reprod Health 6:74–83PubMedCrossRefGoogle Scholar
  60. 60.
    Gage AJ (2007) Barriers to the utilization of maternal health care in rural Mali. Soc Sci Med 65:1666–1682PubMedCrossRefGoogle Scholar
  61. 61.
    Kowalewski M, Mujinja P, Jahn A (2002) Can mothers afford maternal health care costs? User costs of maternity services in rural Tanzania. Afr J Reprod Health 6:65–73PubMedCrossRefGoogle Scholar
  62. 62.
    Mahabub-Ul-Anwar M, Rob U, Talukder MN (2006–2007) Inequalities in maternal health care utilization in rural Bangladesh. Int Q Community Health Educ 27:281–297CrossRefGoogle Scholar
  63. 63.
    Parkhurst JO, Rahman SA, Ssengooba F (2006) Overcoming access barriers for facility based delivery in low-income settings: insights from Bangladesh and Uganda. J Health Popul Nutr 24:438–445PubMedGoogle Scholar
  64. 64.
    Urassa E, Massawe S, Lindmark G et al (1997) Operational factors affecting maternal mortality in Tanzania. Health Policy Plan 12:50–57PubMedCrossRefGoogle Scholar
  65. 65.
    Afsana K, Rashid SF (2001) The challenges of meeting rural Bangladeshi women’s needs in delivery care. Reprod Health Matters 9:79–89PubMedCrossRefGoogle Scholar
  66. 66.
    Afsana K (2004) The tremendous cost of seeking hospital obstetric care in Bangladesh. Reprod Health Matters 12:171–180PubMedCrossRefGoogle Scholar
  67. 67.
    Hasan IJ, Nisar N (2002) Womens’ perceptions regarding obstetric complications and care in a poor fishing community in Karachi. J Pak Med Assoc 52:148–152PubMedGoogle Scholar
  68. 68.
    Mills S, Bertrand JT (2005) Use of health professionals for obstetric care in northern Ghana. Stud Fam Plann 36:45–56PubMedCrossRefGoogle Scholar
  69. 69.
    Mills S, Williams JE, Adjuik M et al (2008) Use of health professionals for delivery following the availability of free obstetric care in northern Ghana. Matern Child Health J 12:509–518PubMedCrossRefGoogle Scholar
  70. 70.
    Pembe AB, Urassa DP, Carlstedt A et al (2009) Rural Tanzanian women’s awareness of danger signs of obstetric complications. MC Pregnancy Childbirth 9:12CrossRefGoogle Scholar
  71. 71.
    Seljeskog L, Sundby J, Chimango J (2006) Factors influencing women’s choice of place of delivery in rural Malawi: an explorative study. Afr J Reprod Health 10:66–75PubMedCrossRefGoogle Scholar
  72. 72.
    Dhakal S, Chapman GN, Simkhada PP et al (2007) Utilisation of postnatal care among rural women in Nepal. BMC Pregnancy Childbirth 7:19PubMedCrossRefGoogle Scholar
  73. 73.
    Hang HM, Byass P (2009) Difficulties in getting treatment for injuries in rural Vietnam. Public Health 123:58–65PubMedCrossRefGoogle Scholar
  74. 74.
    Macharia WM, Njeru EK, Muli-Musiime F et al (2009) Severe road traffic injuries in Kenya, quality of care and access. African Health Sci 9:118–124Google Scholar
  75. 75.
    Mock CN, nii-Amon-Kotei D, Maier RV (1997) Low utilization of formal medical services by injured persons in a developing nation: health service data underestimate the importance of trauma. J Trauma 42:504–511PubMedCrossRefGoogle Scholar
  76. 76.
    Dye TD, Bogale S, Hobden C et al (2010) Complex care systems in developing countries: breast cancer patient navigation in Ethiopia. Cancer 116:577–585PubMedCrossRefGoogle Scholar
  77. 77.
    Forjuoh SN, Guyer B, Strobino DM (1995) Determinants of modern health care use by families after a childhood burn in Ghana. Inj Prev 1:31–34PubMedCrossRefGoogle Scholar
  78. 78.
    Levine AC, Presser DZ, Rosborough S et al (2007) Understanding barriers to emergency care in low-income countries: view from the front line. Prehosp Disaster Med 22:467–470PubMedGoogle Scholar
  79. 79.
    Witwer M (1989) Traditional attitudes, fear of surgery represent important barriers to female sterilization in Zaire. Int Fam Plan Perspect 15:149–150CrossRefGoogle Scholar
  80. 80.
    Bunce A, Guest G, Searing H et al (2007) Factors affecting vasectomy acceptability in Tanzania. Int Fam Plan Perspect 33:13–21PubMedCrossRefGoogle Scholar
  81. 81.
    Bossyns P, Van Lerberghe W (2004) The weakest link: competence and prestige as constraints to referral by isolated nurses in rural Niger. Hum Resource Health 2:1CrossRefGoogle Scholar
  82. 82.
    Ridde V, Morestin F (2011) A scoping review of the literature on the abolition of user fees in health care services in Africa. Health Policy Plan 26:1–11PubMedCrossRefGoogle Scholar
  83. 83.
    Kowalsky RH, Newburger JW, Rand WM et al (2006) Factors determining access to surgery for children with congenital cardiac disease in Guatemala, Central America. Cardiol Young 16:385–391PubMedCrossRefGoogle Scholar
  84. 84.
    Gage AJ, Guirlène Calixte M (2006) Effects of the physical accessibility of maternal health services on their use in rural Haiti. Popul Stud (Camb) 60:271–288CrossRefGoogle Scholar
  85. 85.
    Malhotra R, Uppal Y, Misra A et al (2005) Increasing access to cataract surgery in a rural area: a support strategy. Ind J Public Health 49:63–67Google Scholar
  86. 86.
    Oluleye TS (2004) Cataract blindness and barriers to cataract surgical intervention in three rural communities of Oyo State, Nigeria. Niger J Med 13:156–160PubMedGoogle Scholar
  87. 87.
    Zhou JB, Guan HJ, Qu J et al (2008) A study on the awareness of cataract disease and treatment options in patients who need surgery in a rural area of eastern China. Eur J Ophthalmol 18:544–550PubMedGoogle Scholar
  88. 88.
    Tuladhar H, Khanal R, Kayastha S et al (2009) Complications of home delivery: our experience at Nepal Medical College Teaching Hospital. Nepal Med Coll J 11:164–169PubMedGoogle Scholar
  89. 89.
    Al-Attas AH, Williams CD, Pitchforth EL et al (2010) Understanding delay in accessing specialist emergency eye care in a developing country: eye trauma in Tanzania. Opthalmic Epidemiol 1:103–112CrossRefGoogle Scholar
  90. 90.
    Kirkpatrick M, Lamichhane S (1990) Demographic patterns, attitudes and practices of women attending an antenatal clinic in rural Nepal. J Inst Med 12:37–44PubMedGoogle Scholar
  91. 91.
    Grimes C, Lavy C (2010) A plea for investment in district hospitals. Lancet 376(9758):2073PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2011

Authors and Affiliations

  • Caris E. Grimes
    • 1
  • Kendra G. Bowman
    • 2
  • Christopher M. Dodgion
    • 2
  • Christopher B. D. Lavy
    • 3
  1. 1.Department of General SurgeryEpsom & St. Helier Hospitals NHS TrustCarshaltonUK
  2. 2.Department of Surgery, Center for Surgery and Public HealthBrigham and Women’s HospitalBostonUSA
  3. 3.Department of Orthopaedic Surgery, Nuffield Department of Orthopaedic Surgery, John Radcliffe HospitalUniversity of OxfordOxfordUK

Personalised recommendations