Factors Contributing to and Reducing Delays in the Provision of Adequate Care in Ghana: A Qualitative Study of Trauma Care Providers

Abstract

Background Ghana has a large and growing burden of injury morbidity and mortality. There is a substantial unmet need for trauma surgery, highlighting a need to understand gaps in care. Methods We conducted 8 in-depth interviews with trauma care providers (surgeons, nurses, and specialists) at a large teaching hospital to understand factors that contribute to and reduce delays in the provision of adequate trauma care for severely injured patients. The study aimed to understand whether providers thought factors differed between patients that were enrolled in the National Health Insurance Scheme (NHIS) and those that were not. Findings were presented for the third delay (provision of appropriate care) in the Three Delays Framework.Results Key findings included that most factors contributing delays in the provision of adequate care were related to the costs of care, including for diagnostics, medications, and treatment for patients with and without NHIS subscription. Other notable factors included conflicts between providers, resource constraints, and poor coordination of care at the facility. Factors which reduce delays included advocacy by providers and informal processes for prioritizing critical injuries. ConclusionWe recommend facility-level changes including increasing equity in access to trauma and elective surgery through targeted system strengthening efforts (e.g., a scheduled back-up call system for surgeons, anesthetists, other specialists, and nurses; designated operating theatres and staff for emergencies; training of staff), policy changes to simplify the insurance renewal and subscription processes, and future research on the costs and benefits of including diagnostics, medications, and common trauma services into the NHIS benefits package.

Experiences of injured patients referred to higher levels of care after initial assessment and management at non-tertiary hospitals in Ghana

“…However, for many LMICs, limitations on the workforce, surgical facilities, and patient resources make access to appropriate higher levels of care for trauma patients difficult. [3] , [4] , [5] , [6] This raises the need to understand gaps within the referral system to inform strategies aimed at maintaining the continuum of hospital-based care for the injured. 2 …”

“… 8 Prior work has demonstrated persistent barriers to the referral process in Ghana due to gaps in patient insurance, staff shortages, transportation coverage, reliance upon traditional healers, and incomplete documentation. 4 , 5 , 9 Despite this evidence, the experiences of traumatically injured patients referred from non-tertiary hospitals for definitive care at higher levels remain poorly understood.…”