Challenges and Opportunities in the Provision of Surgical Care in Vanuatu: A Mixed Methods Analysis
- 291 Downloads
The Pacific island nation of Vanuatu faces a number of challenges in delivering surgical care to its population. We aimed to understand and document the barriers, opportunities and required actions to improve surgical care in the country using a mixed methods analysis which incorporated the perspectives of local health stakeholders.
A baseline quantitative assessment of surgical capacity in Vanuatu was carried out using the WHO situational analysis tool. Twenty semi-structured interviews were then conducted on the two main islands (Efate and Espiritu Santo) with surgeons, allied health staff, health managers, policy-makers and other key stakeholders, using a grounded theory qualitative case study methodology. Initial informants were identified by purposive sampling followed by snowball sampling until theoretical saturation was reached. Interviews were open and axially coded with subsequent thematic analysis.
Vanuatu faces deficits in surgical infrastructure, equipment and human resources, especially in the rural provinces. Geographic isolation, poverty and culture—including the use of traditional medicine and low health literacy—all act as barriers to patients accessing timely surgical care. Issues with governance, human resourcing and perioperative care were commonly identified by stakeholders as key challenges facing surgical services. Increasing outreach clinics, developing efficient referral systems, building provincial surgical capacity and undertaking locally led research were identified as key actions that can improve surgical care.
Documenting locally identified challenges and opportunities for surgical care in Vanuatu is an important first step towards developing formal strategies for improving surgical services at the country level.
KeywordsHealth Literacy Surgical Care Surgical Service Qualitative Case Study Western Pacific Region
Compliance with ethical standards
Conflict of interest
No conflicts of interest. Salary costs for Steven Young were met by University of Auckland Studentship fund and travel costs met by the University of Auckland Department of Surgery.
- 2.Debas HT, Gosselin R, McCord C et al (2006) Surgery. In: Jamison DT, Breman JG, Measham AR et al (eds) Disease control priorities in developing countries. World Bank, Washington, DCGoogle Scholar
- 5.World Bank Group (2012) World Bank Data: Pacific island small states. http://www.worldbank.org/en/country/pacificislands/overview. Accessed 18 May 2015
- 6.Vanuatu National Statistics Office (2009) National census of population and housing summary release: basic tables report, vol 1. http://www.spc.int/prism/nada/index.php/catalog/14. Accessed 18 May 2015
- 7.World Health Organisation, Ministry of Health Vanuatu (2012) Health service delivery profile: Vanuatu 2012. http://www.wpro.who.int/health_services/service_delivery_profile_vanuatu.pdf. Accessed 18 May 2015
- 8.World Health Organisation, (2006) The World Health Report 2006: working together for health. http://www.who.int/whr/2006/whr06_en.pdf. Accessed 23 Sep 2015
- 14.Strauss AL, Corbin J (1990) Basics of qualitative research: grounded theory procedures and techniques. Sage Publications, Newbury ParkGoogle Scholar
- 15.Denzin NK, Lincoln YS (1994) Handbook of qualitative research. Sage, Thousand OaksGoogle Scholar
- 22.World Bank Group (2015) World Bank Data: Vanuatu. http://data.worldbank.org/country/vanuatu. Accessed 15 Oct 2015
- 24.World Bank Group (2012) World Bank Data: New Zealand. http://data.worldbank.org/country/new-zealand. Accessed 17 Oct 2015
- 25.Royal Australasian College of Surgeons (2011) Surgical workforce projection to 2025: volume 1 the Australian workforce. http://www.surgeons.org/media/437871/rpt_racs_workforce_projection_to_2025.pdf. Accessed 3 Sep 2015
- 26.Medical Council of New Zealand (2014) The New Zealand Medical Workforce in 2012. http://www.mcnz.org.nz/assets/News-and-Publications/Workforce-Surveys/2012.pdf. Accessed 21 Oct 2015