Prioritising and mapping barriers to achieve equitable surgical care in South Africa: a multi-disciplinary stakeholder workshop

Figures & data

Figure 1. The Four Delays Framework.

Table 1. Barriers to surgical care and their related delays

Barrier	Delay(s)*
Lack of decentralised services	1, 2, 3, 4
Family responsibilities	1, 2, 4
Lack of social support	1, 2, 4
Experienced lack of staff empathy	1, 3, 4
Language barrier	1, 3, 4
Systemic inequities	1, 3, 4
Lack of service user’s surgical healthcare knowledge	1, 4
Lack of surgical health education	1, 4
Procrastination	1, 4
Religion/preference for alternative practitioners	1, 4
Stigma of disease	1, 4
Fear of the individual consequences of surgical care	1
Previous bad experiences	1
Wariness of healthcare system	1
Cancellation of appointments and procedures	2, 3, 4
Lack of continuity of care	2, 3, 4
Lack of funding of public healthcare system	2, 3, 4
Poor communication between service providers at different levels	2, 3, 4
Complex and disjointed referral system	2, 4
Poor road infrastructure	2, 4
Delay of diagnosis	2, 3
Problems with cost, time, safety, distance and comfort of transport	2
Difficulty with navigating the facility	3, 4
Lack of adequate service user records	3, 4
Lack of and poor maintenance of equipment	3, 4
Lack of management, referral and retention in care guidelines	3, 4
Lack of service provider’s knowledge, training and experience	3, 4
Lack of supervision for junior service providers	3, 4
Large burden of disease	3, 4
Limited surgical outreach	3, 4
Long waiting times	3, 4
Lower prioritisation of certain surgical conditions	3, 4
Limited theatre time	3
Lack of home based services	4

*Delay 1: seeking care, Delay 2: reaching care, Delay 3: receiving care, Delay 4: remaining in care.

Table 2. Priority barriers to accessing surgical care in South Africa

Priority	Barrier	Votes
1	Lack of service provider’s knowledge, training and experience	12
2	Limited surgical outreach	11
3	Lack of and poor maintenance of equipment	9
4	Lack of surgical health education	8
5	Lack of decentralised services	8
6	Lack of continuity of care	7
7	Long waiting times	7
8	Complex and disjointed referral system	7
9	Problems with cost, time, safety, distance and comfort of transport	6
10	Lack of social support	5

Figure 2. Map showing barriers, their interconnection, and their relationship with the overarching themes and delays.