Facilitating access to surgical care through a decentralised case-finding strategy: experience in Madagascar

Abstract

Over two-thirds of the world's population lack access to surgical care. Non-governmental organisation's providing free surgeries may overcome financial barriers, but other barriers to care still exist. This analysis paper discusses two different case-finding strategies in Madagascar that aimed to increase the proportion of poor patients, women and those for whom multiple barriers to care exist. From October 2014 to June 2015, we used a centralised selection strategy, aiming to find 70% of patients from the port city, Toamasina, and 30% from the national capital and two remote cities. From August 2015 to June 2016, a decentralised strategy was used, aiming to find 30% of patients from Toamasina and 70% from 11 remote locations, including the capital. Demographic information and self-reported barriers to care were collected. Wealth quintile was calculated for each patient using a combination of participant responses to asset-related and demographic questions, and publicly available data. A total of 2971 patients were assessed. The change from centralised to decentralised selection resulted in significantly poorer patients undergoing surgery. All reported barriers to prior care, except for lack of transportation, were significantly more likely to be identified in the decentralised group. Patients who identified multiple barriers to prior surgical care were less likely to be from the richest quintile (p=0.037) and more likely to be in the decentralised group (p=0.046). Our country-specific analysis shows that decentralised patient selection strategies may be used to overcome barriers to care and allow patients in greatest need to access surgical care.eCollection. Cited Medium: Print. NLM ISO Abbr: BMJ Glob Health. PubMed Central ID: PMC5640035. Linked References: Br J Surg. 2016 Oct;103(11):1453-61. (PMID: 27428044); BMC Health Serv Res. 2017 Jan 23;17 (1):72. (PMID: 28114994); Lancet Glob Health. 2015 Jun;3(6):e316-23. (PMID: 25926087); Lancet. 2015 Apr 27;385 Suppl 2:S11. (PMID: 26313057); Surgery. 2015 Jun;157(6):992-1001. (PMID: 25934081); PLoS One. 2016 Dec 30;11(12 ):e0168867. (PMID: 28036357); World J Surg. 2017 May;41(5):1218-1224. (PMID: 27905017); Indian J Dent Res. 2012 Nov-Dec;23(6):841-2. (PMID: 23649084); Trop Doct. 2017 Oct;47(4):294-299. (PMID: 28682219); Lancet Glob Health. 2015 Apr 27;3 Suppl 2:S38-44. (PMID: 25926319); Ophthalmology. 2016 Jun;123(6):1245-51. (PMID: 26992842); Surgery. 2016 Aug;160(2):501-8. (PMID: 27158120); Med Princ Pract. 2007;16(6):413-9. (PMID: 17917439); World J Surg. 2017 Jan;41(1):14-23. (PMID: 27473131); Ann Surg. 2017 Dec;266(6):975-980. (PMID: 27849672); J Craniofac Surg. 2016 Oct;27(7):1741-1745. (PMID: 27763973); Am Surg. 2013 Sep;79(9):885-8. (PMID: 24069982); Ophthalmic Epidemiol. 2014 Jun;21(3):153-60. (PMID: 24754232); J Surg Res. 2012 Jul;176(1):84-94. (PMID: 22079839); Pediatr Surg Int. 2015 Apr;31(4):389-95. (PMID: 25700687); World J Surg. 2017 Jun;41(6):1435-1446. (PMID: 28120095); Health Policy Plan. 2016 Jul;31(6):706-16. (PMID: 26719347); Anesth Analg. 2017 Jun;124(6):2001-2007. (PMID: 28525513); J West Afr Coll Surg. 2012 Oct;2(4):38-50. (PMID: 25453003). Linking ISSN: 20597908. Subset: PubMed not MEDLINE; Date of Electronic Publication: 2017 Sep 29. ; Original Imprints: Publication: [London] : BMJ Publishing Group Ltd, [2016]- <br />