Systematic Review of Barriers to Surgical Care in Low‐Income and Middle‐Income Countries

Grimes, Caris; Bowman, Kendra G.; Dodgion, Christopher; Lavy, Christopher

doi:10.1007/s00268-011-1010-1

Cited by 344 publications

(317 citation statements)

References 110 publications

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“…[26][27][28] However, similar findings from other LMICs demonstrate that this is not unique to Nepal. [3,5,11,29] Though financial and physical barriers to surgical care must be addressed, demonstrating effectiveness and safety of surgery to the public is an important and often-overlooked aspect of improving access to surgical care in LMICs. [11,30] Trust in the surgical system is particularly important when trying to reduce the burden of surgical disease through elective cases, as patients must present early and on their own volition.…”

Section: Discussionmentioning

confidence: 99%

“…[6,10] Moreover, those in need of surgery face significant access to care barriers including: excessive distance to capable health facilities, poor roads, inability to afford care, fear and mistrust of the healthcare system. [11][12][13] Resultantly, many surgical conditions go untreated, increasing the risk of complications and emergency sequela of their disease. LMICs report significantly higher rates of incarceration, strangulation and death from hernias than high-income countries that have better access to essential surgical care.…”

Section: Introductionmentioning

confidence: 99%

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An estimate of hernia prevalence in Nepal from a countrywide community survey

et al. 2015

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

An estimate of hernia prevalence in Nepal from a countrywide community survey

et al. 2015

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“…In 2010, injuries alone accounted for 11.2 % of ill health in the global adult population. Many of these injuries are surgically treatable, yet a widespread perception persists that surgery is inordinately expensive presents a major barrier to & Erik J. Kramer erik.kramer@yale.edu the implementation of surgery in the global health agenda [2,3]. However, recent studies have demonstrated strong evidence that surgery, including orthopaedic intervention, is often as cost-effective as many non-surgical interventions in widespread use in LMICs [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

The Cost of Intramedullary Nailing for Femoral Shaft Fractures in Dar es Salaam, Tanzania

et al. 2016

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Background Femoral shaft fractures are one of the most common injuries seen by surgeons in low-and middleincome countries (LMICs). Surgical repair in LMICs is often dismissed as not being cost-effective or unsafe, though little evidence exists to support this notion. Therefore, the goal of this study is to determine the cost of intramedullary nailing of femoral shaft fractures in Tanzania. Methods We used micro-costing methods to estimate the fixed and variable costs of intramedullary nailing of femoral shaft fractures. Variable costs assessed included medical personnel costs, ward personnel costs, implants, medications, and single-use supplies. Fixed costs included costs for surgical instruments and administrative and ancillary staff. Results 46 adult femoral shaft fracture patients admitted to Muhimbili Orthopaedic Institute between June and September 2014 were enrolled and treated with intramedullary fixation. The total cost per patient was $530

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“…Limited surgical specialists are often cited as a barrier to accessing surgical care at district hospitals11 16, 17, 18, 19. Although the cost of the surgeon's time contributed about 60 per cent of the total personnel costs, the overall cost of personnel was still lower than that of medicines or supplies.…”

Section: Discussionmentioning

confidence: 99%

Assessing the cost of laparotomy at a rural district hospital in Rwanda using time-driven activity-based costing

et al. 2018

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BackgroundIn low‐ and middle‐income countries, the majority of patients lack access to surgical care due to limited personnel and infrastructure. The Lancet Commission on Global Surgery recommended laparotomy for district hospitals. However, little is known about the cost of laparotomy and associated clinical care in these settings.MethodsThis costing study included patients with acute abdominal conditions at three rural district hospitals in 2015 in Rwanda, and used a time‐driven activity‐based costing methodology. Capacity cost rates were calculated for personnel, location and hospital indirect costs, and multiplied by time estimates to obtain allocated costs. Costs of medications and supplies were based on purchase prices.ResultsOf 51 patients with an acute abdominal condition, 19 (37 per cent) had a laparotomy; full costing data were available for 17 of these patients, who were included in the costing analysis. The total cost of an entire care cycle for laparotomy was US$1023·40, which included intraoperative costs of US$427·15 (41·7 per cent) and preoperative and postoperative costs of US$596·25 (58·3 per cent). The cost of medicines was US$358·78 (35·1 per cent), supplies US$342·15 (33·4 per cent), personnel US$150·39 (14·7 per cent), location US$89·20 (8·7 per cent) and hospital indirect cost US$82·88 (8·1 per cent).ConclusionThe intraoperative cost of laparotomy was similar to previous estimates, but any plan to scale‐up laparotomy capacity at district hospitals should consider the sizeable preoperative and postoperative costs. Although lack of personnel and limited infrastructure are commonly cited surgical barriers at district hospitals, personnel and location costs were among the lowest cost contributors; similar location‐related expenses at tertiary hospitals might be higher than at district hospitals, providing further support for decentralization of these services.

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Systematic Review of Barriers to Surgical Care in Low‐Income and Middle‐Income Countries

Cited by 344 publications

References 110 publications

An estimate of hernia prevalence in Nepal from a countrywide community survey

An estimate of hernia prevalence in Nepal from a countrywide community survey

The Cost of Intramedullary Nailing for Femoral Shaft Fractures in Dar es Salaam, Tanzania

Assessing the cost of laparotomy at a rural district hospital in Rwanda using time-driven activity-based costing

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