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

Area of Science:

• Global Health
• Surgical Care Access
• Health Equity

Background:

• Over two-thirds of the global population lack access to essential surgical care.
• Financial barriers are often addressed by non-governmental organizations, but other significant barriers persist.
• Targeting vulnerable populations, including the poor and women, remains a challenge in surgical care delivery.

Purpose of the Study:

• To compare the effectiveness of centralized versus decentralized case-finding strategies in Madagascar.
• To increase the proportion of patients from disadvantaged groups accessing surgical care.
• To identify and address multiple barriers to surgical care among underserved populations.

Main Methods:

• Analysis of two distinct patient selection strategies: centralized (Oct 2014-Jun 2015) and decentralized (Aug 2015-Jun 2016).
• Data collection included demographics, self-reported barriers to care, and wealth quintile calculation for 2971 patients.
• Comparison of patient characteristics and reported barriers between the two strategies.

Main Results:

• The decentralized strategy resulted in significantly poorer patients undergoing surgery.
• All reported barriers to prior care, except transportation, were more prevalent in the decentralized group.
• Patients reporting multiple barriers were less likely to be wealthy and more likely to be in the decentralized group.

Conclusions:

• Decentralized patient selection strategies are effective in overcoming barriers to surgical care.
• This approach enhances access for patients in greatest need, improving surgical equity in resource-limited settings.
• Tailored strategies are crucial for reaching underserved populations requiring surgical interventions.