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dc.contributor.authorRaykar, NP
dc.contributor.authorYorlets, RR
dc.contributor.authorLiu, C
dc.contributor.authorGoldman, R
dc.contributor.authorGreenberg, SLM
dc.contributor.authorKotagal, M
dc.contributor.authorFarmer, PE
dc.contributor.authorMeara, JG
dc.contributor.authorRoy, N
dc.contributor.authorGillies, RD
dc.date.accessioned2020-12-18T04:28:06Z
dc.date.available2020-12-18T04:28:06Z
dc.date.issued2016-11-01
dc.identifierpii: bmjgh-2016-000075
dc.identifier.citationRaykar, N. P., Yorlets, R. R., Liu, C., Goldman, R., Greenberg, S. L. M., Kotagal, M., Farmer, P. E., Meara, J. G., Roy, N. & Gillies, R. D. (2016). The How Project: understanding contextual challenges to global surgical care provision in low-resource settings. BMJ GLOBAL HEALTH, 1 (4), https://doi.org/10.1136/bmjgh-2016-000075.
dc.identifier.issn2059-7908
dc.identifier.urihttp://hdl.handle.net/11343/256206
dc.description.abstractINTRODUCTION: 5 billion people around the world do not have access to safe, affordable, timely surgical care. This series of qualitative interviews was launched by The Lancet Commission on Global Surgery (LCoGS) with the aim of understanding the contextual challenges-the specific circumstances-faced by surgical care providers in low-resource settings who care for impoverished patients, and how those providers overcome these challenges. METHODS: From January 2014 to February 2015, 20 LCoGS collaborators conducted semistructured interviews with 148 surgical providers in low-resource settings in 21 countries. Stratified purposive sampling was used to include both rural and urban providers, and reputational case selection identified individuals. Interviewers were trained with an implementation manual. Following immersion into de-identified texts from completed interviews, topical coding and further analysis of coded texts was completed by an independent analyst with periodic validation from a second analyst. RESULTS: Providers described substantial financial, geographic and cultural barriers to patient access. Rural surgical teams reported a lack of a trained workforce and insufficient infrastructure, equipment, supplies and banked blood. Urban providers face overcrowding, exacerbated by minimal clinical and administrative support, and limited interhospital care coordination. Many providers across contexts identified national health policies that do not reflect the realities of resource-poor settings. Some findings were region-specific, such as weak patient-provider relationships and unreliable supply chains. In all settings, surgical teams have created workarounds to deliver care despite the challenges. DISCUSSION: While some differences exist between countries, the barriers to safe surgery and anaesthesia are overall consistent and resource-dependent. Efforts to advance and expand global surgery must address these commonalities, while local policymakers can tailor responses to key contextual differences.
dc.languageEnglish
dc.publisherBMJ PUBLISHING GROUP
dc.rights.urihttps://creativecommons.org/licenses/by-nc/4.0
dc.titleThe How Project: understanding contextual challenges to global surgical care provision in low-resource settings
dc.typeJournal Article
dc.identifier.doi10.1136/bmjgh-2016-000075
melbourne.affiliation.departmentPaediatrics (RCH)
melbourne.affiliation.departmentMedicine, Western Health
melbourne.affiliation.facultyMedicine, Dentistry & Health Sciences
melbourne.source.titleBMJ Global Health
melbourne.source.volume1
melbourne.source.issue4
dc.rights.licenseCC BY-NC
melbourne.elementsid1215044
melbourne.contributor.authorMeara, John
melbourne.contributor.authorGreenberg, Sally
dc.identifier.eissn2059-7908
melbourne.accessrightsOpen Access


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