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 Bagawhira, Theophile Dushime, Darius Erlangga, Christophe Mpirimbanyi, Severien Muneza, Menelas Nkeshimana, Martin Nyundo, Christian Umuhoza, Eric Uwitonce, Jill Steans, Ali Rushton, Tony Belli, Jean Claude Byiringiro, Abebe Bekele, Justine Davies

Research output: Contribution to journalArticlepeer-review

116 Downloads (Pure)


Whilst injuries are a major cause of disability and death worldwide, a large proportion of people in low and middle-income countries (LMICs) 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
JournalWorld journal of surgery
Publication statusAccepted/In press - 28 Apr 2020


  • Trauma
  • Global Surgery


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