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Systematic review of barriers to surgical care in low-income and middle-income countries. World J Surg 2011 May;35(5):941-50

Date

03/02/2011

Pubmed ID

21360305

DOI

10.1007/s00268-011-1010-1

Scopus ID

2-s2.0-79955688948   197 Citations

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.

Author List

Grimes CE, Bowman KG, Dodgion CM, Lavy CB

Author

Christopher M. Dodgion MD Associate Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Culture
Family
Health Services Accessibility
Hospitals, District
Humans
Income
Patient Acceptance of Health Care
Poverty
Social Support
Surgical Procedures, Operative