Technical Priorities for Orthopaedic Trauma Care Development in Malawi

Malawi has a high and rising incidence of musculoskeletal injuries and inadequate orthopaedic trauma care capacity, which must be urgently addressed.

We performed a scoping literature review to define essential goals and challenges to musculoskeletal trauma care delivery in Malawi pertaining to the following domains: injury prevention, prehospital care, rural health centres, district hospitals, and central hospitals. For each domain, essential goals were ratified and challenges were prioritized by a panel of experts on Malawian orthopaedic trauma care.

The five highest priorities pertained to injury prevention (2), central hospital-level definitive treatment (2), and district hospital-level initial fracture management (1). We believe the next steps are to use the prioritized list of challenges to form working groups with the goal of examining and developing strategies to address each challenge. For the top priority challenges in each domain, we recommend the following: 1) Prevent road injuries by law enforcement, children's education, civic engagement, and road infrastructure development; 2) Improve pre-hospital transportation by scaling up emergency dispatch systems, fixing broken ambulances, and training public transportation workers in basic first aid; 3) Provide health workers in Rural Health Centres with basic training in musculoskeletal injury management and triage; 4) Improve diagnostic x-ray capacity at District Hospitals by fixing/replacing broken machinery and ensuring stable power supply; 5) Improve operative capacity at Central Hospitals by increasing operating theatre availability, efficiency, and utilization, and supporting specialist surgical training programmes.

We hope that this manuscript will serve as a practical, actionable guide for policymakers, donors, health system leaders, educators and orthopaedic trauma care providers. Through this process, we also hope to create a replicable methodology and framework that can be applied to other clinical departments in Malawi, and for similar work in other low- and middle-income countries.