Challenges and solutions to providing surgery in Sierra Leone hospitals: a qualitative analysis of surgical provider perspectives
Open Access
Abstract
Objective This study aimed to use qualitative interviews with surgical providers to explore challenges and solutions to providing surgical and anaesthesia care in Sierra Leone’s hospitals. Design Data were collected through anonymous, semistructured interviews. We used a qualitative framework approach to analyse interview data and determine themes relating to challenges that were reported. Setting A purposive sample of 12 hospitals was selected throughout Sierra Leone to include district and referral hospitals of varying ownership (private, non-governmental organisation and government). Participants The most senior surgical provider available during each hospital site visit participated in a semistructured interview. A total of 12 interviews were conducted. Results Providers described both challenges and solutions relating to the following categories: equipment and supplies, access to services, human resources, infrastructure, management and patient factors. These challenges were found to affect surgical care in hospitals by delaying surgical care, decreasing operative capacity and decreasing quality of care. Providers identified not only the root causes of these challenges, but also the varied workarounds and solutions they employ to overcome them. Conclusion Surgical providers can offer important insights into challenges affecting surgical services in hospitals. Despite working in challenging environments with limited resources, providers have developed innovative solutions to improve surgical and anaesthesia care in hospitals in Sierra Leone. Qualitative research has an important role to play in improving understanding of the challenges facing surgeons in low-income countries.Keywords
Funding Information
- King's College London
This publication has 47 references indexed in Scilit:
- Validation of the World Health Organization Tool for Situational Analysis to Assess Emergency and Essential Surgical Care at District Hospitals in GhanaWorld Journal of Surgery, 2010
- Essential Surgery at the District Hospital: A Retrospective Descriptive Analysis in Three African CountriesPLOS Medicine, 2010
- Human Resource and Funding Constraints for Essential Surgery in District Hospitals in Africa: A Retrospective Cross-Sectional SurveyPLOS Medicine, 2010
- Rural Tanzanian women's awareness of danger signs of obstetric complicationsBMC Pregnancy and Childbirth, 2009
- A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global PopulationNew England Journal of Medicine, 2009
- Motorcycle ambulances for referral of obstetric emergencies in rural Malawi: Do they reduce delay and what do they cost?International Journal of Gynecology & Obstetrics, 2008
- Patterns of Communication Breakdowns Resulting in Injury to Surgical PatientsJournal of the American College of Surgeons, 2007
- Qualitative research in health care: Analysing qualitative dataBMJ, 2000
- The “three delays” as a framework for examining maternal mortality in HaitiSocial Science & Medicine, 1998
- Too far to walk: Maternal mortality in contextSocial Science & Medicine, 1994