Identifying, Prioritizing and Visually Mapping Barriers to Injury Care in Rwanda: A Multi-disciplinary Stakeholder Exercise

Maria Lisa Odland, John Whitaker, Dmitri Nepogodiev, Carolyn Achieng’ Aling’, Irene Bagahirwa, Theophile Dushime, Darius Erlangga, Christophe Mpirimbanyi, Severien Muneza, Menelas Nkeshimana, Martin Nyundo, Christian Umuhoza, Eric Uwitonze, Jill Steans, Alison Rushton, Antonio Belli, Jean Claude Byiringiro, Abebe Bekele, Justine Davies

Research output: Contribution to journalArticlepeer-review

25 Citations (Scopus)


Whilst injuries are a major cause of disability and death worldwide, a large proportion of people in low- and middle-income countries lack timely access to injury care. Barriers to accessing care from the point of injury to return to function have not been delineated.

A two-day workshop was held in Kigali, Rwanda in May 2019 with representation from health providers, academia, and government. A four delays model (delays to seeking, reaching, receiving, and remaining in care) was applied to injury care. Participants identified barriers at each delay and graded, through consensus, their relative importance. Following an iterative voting process, the four highest priority barriers were identified. Based on workshop findings and a scoping review, a map was created to visually represent injury care access as a complex health-system problem.

Initially, 42 barriers were identified by the 34 participants. 19 barriers across all four delays were assigned high priority; highest-priority barriers were “Training and retention of specialist staff”, “Health education/awareness of injury severity”, “Geographical coverage of referral trauma centres”, and “Lack of protocol for bypass to referral centres”. The literature review identified evidence relating to 14 of 19 high-priority barriers. Most barriers were mapped to more than one of the four delays, visually represented in a complex health-system map.

Overcoming barriers to ensure access to quality injury care requires a multifaceted approach which considers the whole patient journey from injury to rehabilitation. Our results can guide researchers and policymakers planning future interventions.
Original languageEnglish
Pages (from-to)2903-2918
Number of pages16
JournalWorld Journal of Surgery
Issue number9
Publication statusPublished - 1 Sept 2020


Dive into the research topics of 'Identifying, Prioritizing and Visually Mapping Barriers to Injury Care in Rwanda: A Multi-disciplinary Stakeholder Exercise'. Together they form a unique fingerprint.

Cite this