877 Demand-Side Barriers to Surgical Care in Low- and Middle-Income Countries - a Scoping Review

Abstract

Abstract Aim Thirty per cent of diseases worldwide can be treated by surgery or require the direct care of a surgeon. The Lancet Commission (2015) found that five billion people lack access to safe surgery, predominately those living in low- and middle-income countries, where nine out of ten people cannot access basic surgical care. Numerous studies have examined supply-side barriers, but few have examined the demand-side. We report a scoping review to identify and explore the barriers that prevent patients from seeking surgical care. Method A systematic search of multiple databases using the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines was conducted, looking for papers published between January 2015 and November 2023. Two independent reviewers charted qualitative variables and significant demographic data. Results Out of 2,899 studies examined, 228 met the inclusion criteria. The studies spanned six continents and fifty-seven countries. 14% were multi-country. Forty-seven barriers were identified and organised under ten headings. The five most frequently cited barriers were distance, fear/lack of trust, transport costs, reliance on religious/traditional healers and indirect costs (food/accommodation/companion). Conclusions Our review demonstrates the breadth of barriers contributing to the unmet need for surgery amongst all surgical specialities. While countries pursue their 2030 target to increase the provision of safe surgical care, there also needs to be a clear focus on understanding the factors that prevent patients from accessing established surgical care and how to mitigate them.