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. GrimesEmail author
  • Kendra G. Bowman
  • Christopher M. Dodgion
  • Christopher B. D. Lavy



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.


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.


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.


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.


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.


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Copyright information

© Société Internationale de Chirurgie 2011

Authors and Affiliations

  • Caris E. Grimes
    • 1
    Email author
  • 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

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