‘I think we are going to leave these cases’. Obstacles to surgery in rural Malawi: a qualitative study of provider perspectives

Surgical services at district level in Malawi are poor, yet the majority of the population resides in rural areas. This study aimed to explore the perceived obstacles to surgery from the perspective of the cadre directly responsible for surgical service delivery at district hospitals.

[1]  A. Acharya,et al.  Constraints to Implementing the Essential Health Package in Malawi , 2011, PloS one.

[2]  D. Hansen,et al.  Anaesthesia in Malawi: Complications and Deaths , 2000, Tropical doctor.

[3]  K. Chung,et al.  Building Surgical Capacity in Low-Resource Countries: A Qualitative Analysis of Task Shifting From Surgeon Volunteers’ Perspectives , 2014, Annals of plastic surgery.

[4]  R. Brugha,et al.  Who accesses surgery at district level in sub‐Saharan Africa? Evidence from Malawi and Zambia , 2017, Tropical medicine & international health : TM & IH.

[5]  A. Michaels Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. , 2019, Bulletin of the American College of Surgeons.

[6]  D. Khalil Nurses' attitude towards ‘difficult’ and ‘good’ patients in eight public hospitals , 2009 .

[7]  Delanyo Dovlo,et al.  Non-physician Clinicians – A Gain for Physicians’ Working in Sub-Saharan Africa , 2016, International journal of health policy and management.

[8]  G. Pollach,et al.  The Anaesthetic Friendship Society - supporting anaesthetic clinical officers in the southern districts of Malawi. , 2013, Malawi medical journal : the journal of Medical Association of Malawi.

[9]  S. Hobson,et al.  Retrospective review of Surgical Availability and Readiness in 8 African countries , 2017, BMJ Open.

[10]  M. De Allegri,et al.  Universal health coverage from multiple perspectives: a synthesis of conceptual literature and global debates , 2015, BMC International Health and Human Rights.

[11]  N. Ford,et al.  Surgical Task Shifting in Sub-Saharan Africa , 2009, PLoS medicine.

[12]  M. Hollands,et al.  World Health Assembly Resolution WHA68.15: “Strengthening Emergency and Essential Surgical Care and Anesthesia as a Component of Universal Health Coverage”—Addressing the Public Health Gaps Arising from Lack of Safe, Affordable and Accessible Surgical and Anesthetic Services , 2015, World Journal of Surgery.

[13]  H. Mothes,et al.  The Amsterdam Declaration on Essential Surgical Care , 2015, World Journal of Surgery.

[14]  R. Brugha,et al.  Quality of Surgery in Malawi: Comparison of Patient-Reported Outcomes After Hernia Surgery Between District and Central Hospitals , 2018, World Journal of Surgery.

[15]  C. Lavy,et al.  Orthopaedic Clinical Officer Program in Malawi: A Model for Providing Orthopaedic Care , 2008, Clinical orthopaedics and related research.

[16]  S. Merry Is it Possible to Train Surgeons for Rural Africa? A Report of a Successful International Program , 2011, World Journal of Surgery.

[17]  C. Grimes,et al.  Systematic Review of Met and Unmet Need of Surgical Disease in Rural Sub-Saharan Africa , 2011, World Journal of Surgery.

[18]  A. Gillespie,et al.  Patient neglect in healthcare institutions: a systematic review and conceptual model , 2013, BMC Health Services Research.

[19]  K. Jacobsen,et al.  Trauma and orthopaedic capacity of 267 hospitals in east central and southern Africa , 2015, The Lancet.

[20]  Phil Hider,et al.  Estimated need for surgery worldwide based on prevalence of diseases: a modelling strategy for the WHO Global Health Estimate. , 2015, The Lancet. Global health.

[21]  R. Brugha,et al.  Non-physician clinicians in rural Africa: lessons from the Medical Licentiate programme in Zambia , 2017, Human Resources for Health.

[22]  C. Lavy,et al.  Surgical facilities available at district hospitals in Malawi. , 2007, Malawi medical journal : the journal of Medical Association of Malawi.

[23]  R. Dicker,et al.  Barriers and facilitators of surgical care in rural Uganda: a mixed methods study. , 2016, The Journal of surgical research.

[24]  Christopher M. Dodgion,et al.  Systematic Review of Barriers to Surgical Care in Low-Income and Middle-Income Countries , 2011, World Journal of Surgery.

[25]  L. Pearson,et al.  Availability and use of emergency obstetric services: Kenya, Rwanda, Southern Sudan, and Uganda , 2005, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[26]  B. Cotton,et al.  Problems and solutions in delivering global surgery in the 21st century , 2016, The British journal of surgery.

[27]  N. Abrahams,et al.  Why do nurses abuse patients? Reflections from South African obstetric services. , 1998, Social science & medicine.

[28]  Richard E. Boyatzis,et al.  Transforming Qualitative Information: Thematic Analysis and Code Development , 1998 .

[29]  Margaret E Kruk,et al.  Access to emergency and surgical care in sub-Saharan Africa: the infrastructure gap. , 2012, Health policy and planning.

[30]  A. Gawande,et al.  Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development , 2015, The Lancet.

[31]  N. Mkandawire,et al.  Surgical and anaesthetic capacity of hospitals in Malawi: key insights , 2014, Health policy and planning.

[32]  T. Manyazewal Using the World Health Organization health system building blocks through survey of healthcare professionals to determine the performance of public healthcare facilities , 2017, Archives of Public Health.

[33]  V. Braun,et al.  Using thematic analysis in psychology , 2006 .

[34]  David A Spiegel,et al.  Addressing the Millennium Development Goals from a surgical perspective: essential surgery and anesthesia in 8 low- and middle-income countries. , 2010, Archives of surgery.

[35]  C. Lavy,et al.  Surgery in Malawi - a national survey of activity in rural and urban hospitals. , 2007, Annals of the Royal College of Surgeons of England.

[36]  F. Mullan,et al.  Non-physician clinicians in 47 sub-Saharan African countries , 2007, The Lancet.

[37]  K. Chung,et al.  Qualitative Analysis of the Perspectives of Volunteer Reconstructive Surgeons on Participation in Task-Shifting Programs for Surgical-Capacity Building in Low-Resource Countries , 2013, World Journal of Surgery.