Patient-Reported Barriers to Accessing Surgical Care in Northern Vanuatu

Area of Science:

• Global Surgery
• Health Systems Research
• Health Equity

Background:

• The Lancet Commission emphasizes 2-hour access to essential surgical care as a key health system indicator.
• Limited data exists on surgical care access in island nations like Vanuatu, a lower-middle-income country.

Purpose of the Study:

• To characterize access to surgical care in Vanuatu using the 'three delays' framework.
• To evaluate patient demographics and clinical outcomes for surgical inpatients at Northern Provincial Hospital.

Main Methods:

• A 6-month, facility-based survey of surgical inpatients at Northern Provincial Hospital, Vanuatu.
• Data collection included patient demographics, reasons for delay in seeking care, and clinical outcomes.

Main Results:

• 121 patients surveyed; 31% required emergency surgery, with only 20% accessing care within 2 hours.
• The primary barrier to timely access was the 'first delay' (delay in seeking care).
• Geographic, gender, and sociocultural factors (preference for traditional healers) significantly impacted access.

Conclusions:

• Urgent improvements in surgical care access are needed in Vanuatu, especially for remote regions like Torba and Malekula.
• Addressing demographic, geographic, sociocultural, and economic barriers is crucial and more complex than resource availability alone.
• Future efforts should focus on reducing initial delays in seeking care, integrating traditional medicine considerations, and mitigating geographic disparities.