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Strategic Assessment of Trauma Care Capacity in Ghana

Abstract

Background

This study aimed to assess availability of trauma care technology in Ghana. In addition, factors contributing to deficiencies were evaluated. By doing so, potential solutions to inefficient aspects of health systems management and maladapted technology for trauma care in low- and middle-income countries (LMICs) could be identified.

Methods

Thirty-two items were selected from the World Health Organization’s Guidelines for Essential Trauma Care. Direct inspection and structured interviews with administrative, clinical, and biomedical engineering staff were used to assess the challenges and successes of item availability at 40 purposively sampled district, regional, and tertiary hospitals.

Results

Hospital assessments demonstrated marked deficiencies. Some of these were low cost, such as basic airway supplies, chest tubes, and cervical collars. Item non-availability resulted from several contributing factors, namely equipment absence, lack of training, frequent stock-outs, and technology breakage. A number of root causes for these factors were identified, including ineffective healthcare financing by way of untimely national insurance reimbursements, procurement and stock-management practices, and critical gaps in local biomedical engineering and trauma care training. Nonetheless, local examples of successfully overcoming deficiencies were identified (e.g., public–private partnering, ensuring company engineers trained technicians on-the-job during technology installation or servicing).

Conclusion

While availability of several low-cost items could be better supplied by improvements in stock-management and procurement policies, there is a critical need for redress of the national insurance reimbursement system and trauma care training of district hospital staff. Further, developing local service and technical support capabilities is more and more pressing as technology plays an increasingly important role in LMIC healthcare systems.

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Acknowledgments

This study was funded in part by Grants from the University of Washington Department of Surgery Research Reinvestment Fund and grants (R25-TW009345; D43-TW007267) 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 Godfred Boakye, Victor Oppong-Nketia, and Adolfo Koranteng for their assistance with field visits and Melissa Tosch for her insight into logistics, finance, and supply chain management. In addition, we thank the Ghana Ministry of Health and Regional Health Directorates for facilitating hospital visits.

Author information

Correspondence to Barclay T. Stewart.

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No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

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Stewart, B.T., Quansah, R., Gyedu, A. et al. Strategic Assessment of Trauma Care Capacity in Ghana. World J Surg 39, 2428–2440 (2015). https://doi.org/10.1007/s00268-015-3132-3

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Keywords

  • Chest Tube
  • Trauma Care
  • National Health Insurance Scheme
  • Cervical Collar
  • Nurse Anesthetist