Overcoming Barriers to Accessing Surgery and Rehabilitation in Low and Middle-Income Countries: An Innovative Model of Patient Navigation in Nepal

Jennifer L. Ibbotson,Kathryn R. Jagt,Bijata Luitel,Bikash Adhikari,Erik Bohler,Geoffrey C. Ibbotson,Robert Riviello

doi:10.1007/s00268-021-06035-1

Abstract

BackgroundInjury and disability are prominent public health concerns, globally and in the country of Nepal. Lack of locally available medical infrastructure, socioeconomic barriers, social marginalization, poor health literacy, and cultural barriers prevent patients from accessing surgical and rehabilitative care. Overcoming these barriers is an insurmountable challenge for the most vulnerable and marginalized, resulting in absence of treatment or even death.MethodsSundar Dhoka Saathi Sewa (SDSS), a non-government organization, provides a patient navigation service which facilitates referrals to tertiary centers from Nepal’s most remote areas. Specific criteria ensure that patient referrals are appropriate in regard to clinical and socioeconomic need, while comprehensive counselling helps guide the patient and family. The SDSS staff meet patients upon arrival in Kathmandu and facilitate admission to the appropriate tertiary hospital. They advocate for the patient, provide medicine, supply food and cover all treatment costs.ResultsThis project has enabled access to treatment for more than 1200 children for conditions leading to long-term disability and/or congenital heart disease. Interventions include a wide range of surgical and rehabilitative procedures such as complex orthopedics, cleft lip and palate, congenital talipes equinovarus, burn contractures, neurological cases, and cardiac surgery for valvular disease, septal defects and other congenital malformations.DiscussionThe SDSS model of patient navigation is effective in overcoming the barriers to access surgical care and rehabilitation in Nepal. The success is owed to committed international donors, capacity building, effective counselling, advocacy, compassion, and community. We believe that this model could be replicated in other LMICs.

Highlights

Injury and disability are prominent public health concerns, globally and in the country of Nepal
The Sundar Dhoka Saathi Sewa (SDSS) model of patient navigation is effective in overcoming the barriers to access surgical care and rehabilitation in Nepal
The success is owed to committed international donors, capacity building, effective counselling, advocacy, compassion, and community. We believe that this model could be replicated in other low- and middle-income countries (LMIC)

Summary

Introduction

Injury and disability are prominent public health concerns, globally and in the country of Nepal. Lack of locally available medical infrastructure, socioeconomic barriers, social marginalization, poor health literacy, and cultural barriers prevent patients from accessing surgical and rehabilitative care. Overcoming these barriers is an insurmountable challenge for the most vulnerable and marginalized, resulting in absence of treatment or even death. Traumatic injury alone causes more fatalities than malaria, TB and HIV combined [1, 2] Of those who survive their injuries, many suffer from significant disability as a direct result of delayed, non-existent or inadequate access to surgical management and rehabilitation care. The World Bank, the Lancet Commission on Global Surgery, and the United Nations have called upon all countries to ensure that no one is forced into poverty due to the costs of medical care [7,8,9,10]

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