Delays to accessing healthcare and rehabilitation following trauma in Madagascar – a qualitative study

Abstract

Purpose

To explore the factors affecting access to timely trauma care and rehabilitation in Madagascar.

Materials and methods

A qualitative study based in the outpatient departments of two large rehabilitation centres. Semi-structured interviews and focus groups were conducted with 12 patients or family members and 11 healthcare professionals. Interviews and focus groups were conducted with a local interpreter and were audio-recorded and transcribed. The data were analysed deductively with thematic content analysis, utilising the Health Care Access Barriers model.

Results

Participants experienced delays in deciding to seek treatment, accessing healthcare facilities and in receiving appropriate treatment. Cognitive barriers included understanding and awareness of healthcare, structural barriers included distance and transportation to health facilities, financial barriers included affordability of healthcare and difficulty accessing funds.

Conclusions

Delays to accessing healthcare may result in increased mortality and disability following trauma, as well as increased financial burden. Addressing the acceptability of services should be a focus for future service development, through training and education schemes. More importantly, improving both physical and financial accessibility of services must be a long-term priority. These findings may help to guide the ongoing development of trauma and rehabilitation pathways in Madagascar.

IMPLICATIONS FOR REHABILITATION

• Delays in accessing timely trauma care and rehabilitation can lead to complications such as pain, infection, malunion of fractures and loss of function, with devastating financial and social consequences for patients and their families.

• The acceptability of services is a key barrier to accessing hospital care and may be targeted through training schemes for healthcare professionals and education for the public.

• Improving the physical and financial accessibility of services in the long-term is paramount.

• Consideration should be given to these issues in the future development of co-ordinated trauma care and rehabilitation pathways in Madagascar.

Keywords:

• Health services accessibility
• wounds and injuries
• rehabilitation
• global health
• disability

Acknowledgements

The authors would like to thank the interpreter Sedera Onja, all the healthcare professionals who helped with the study, in particular Dr. Renaud Rakotonirainy and Dr. Sonia Andrianabela for their support and advice, and the patients and families that contributed to this project. We acknowledge and thank the British Society of Rehabilitation Medicine for their funding and support. RJOC’s research is supported by the National Institute for Health Research (NIHR) infrastructure at Leeds and Sheffield. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research was supported by the inaugural award of the Professor Bipin Bhakta Memorial Postgraduate Research Travelling Scholarship from the British Society of Rehabilitation Medicine, which was awarded to the author HNL.