Related Experiment Video
Updated: May 9, 2026
Clinical Application of 24 G Cannula Needle and 3-0 Polypropylene Suture in Vas Deferens Exploration
Published on: February 10, 2023
Challenges and enablers in accessing paediatric inguinal hernia surgical care in Sierra Leone: a qualitative
Johanna Mona1, Johan G Ahlbäck2, Aiah Lebbie3
1Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Trøndelag, Norway.
Insights
Access to paediatric inguinal hernia surgery in Sierra Leone is limited by financial barriers, low awareness, and shortages of staff and supplies. Improving access requires community outreach and expanding healthcare initiatives.
Area of Science:
- Global Surgery
- Paediatric Surgery
- Health Systems Research
Background:
- Paediatric inguinal hernia repair is a common surgical procedure.
- Access to essential surgical care remains a challenge in low-income countries.
- Sierra Leone faces significant health system constraints.
Purpose of the Study:
- To identify barriers and facilitators to accessing paediatric inguinal hernia surgery.
- To explore the experiences of healthcare providers and guardians of children.
- To inform strategies for improving surgical care access in Sierra Leone.
Main Methods:
- Qualitative exploratory interview study.
- Semistructured interviews with 16 healthcare providers and 19 guardians.
- Thematic analysis and framework-based interpretation using WHO health system building blocks.
Main Results:
- Key barriers include shortages of equipment, medicines, and workforce; limited health-seeking behavior; financial constraints; and management issues.
- Interacting household and health system factors impede surgical access.
- Enablers include task-sharing, community trust, and financial protection initiatives.
Conclusions:
- Economic barriers, limited awareness, and resource shortages hinder paediatric hernia surgery access.
- Strategies include community outreach, expanding the Free Healthcare Initiative, and dedicated paediatric surgical equipment.
- Improving access requires addressing both health system and household-level challenges to enhance equity of care.
Objective:
To assess challenges and enablers in accessing paediatric inguinal hernia surgical care at governmental hospitals in Sierra Leone.
Methodology:
A qualitative exploratory interview study was conducted using semistructured interviews with 16 healthcare providers and 19 guardians of 17 children at four governmental secondary-level and tertiary-level hospitals in Sierra Leone. All interviews were analysed using thematic analysis within a constructivist paradigm, with subsequent framework-based interpretation using the WHO health system building blocks.
Results:
The study identified five interrelated themes describing barriers to accessing surgical care across household and health system levels: (1) access to equipment, consumables and medicines; (2) health-seeking behaviour; (3) financial considerations; (4) workforce; and (5) management and hospital structure. These themes illustrate how health system constraints and household-level barriers interact to delay or impede access to surgery. Key enablers included task-sharing within the surgical workforce, community trust and financial protection through the Free Healthcare Initiative or non-governmental organisations.
Conclusion:
Access to paediatric inguinal hernia surgery in Sierra Leone is hindered by economic barriers, limited awareness and shortages of staff, equipment and medicines. Targeted community outreach, expansion of the Free Healthcare Initiative beyond age 5 and securing dedicated paediatric surgical instrument sets emerged as feasible strategies to reduce delays and improve equity of care.