Barriers to prosthetic devices at a Tanzanian hospital

Abstract

Background: Limb amputation, often from road trauma, is common in low-income countries. Providing prosthetic devices for amputees is challenging and limited research exists regarding barriers to prosthesis provision. This study aims to elucidate the Prosthesis Provision Pathway (PPP) and identify barriers of prosthesis accessibility at the Muhimbili Orthopaedic Institute (MOI) in Dar es Salaam, Tanzania.

Patients and Methods: At MOI, 18 healthcare providers, who included 4 orthopaedic technicians, 4 physical therapists, 4 orthopaedic surgeons, 4 junior doctors, and 2 hospital administrators were interviewed and blinded. Responses from semi-structured interviews were transcribed and common themes were identified. A process map diagramming the prosthesis provision pathway was created to highlight barriers and potential areas of improvement.

Results: Six main themes emerged from the interviews: the first is that the prosthetics are expensive both for patients and MOI. Second, there are misperceptions of how prosthesis cost will be distributed. Third, there is inefficient communication between providers. Fourth, improved surgical education is needed to improve amputation outcomes. Fifth, amputees face psychosocial stigma, but prosthetics are becoming more accepted. Lastly, healthcare providers understand that trauma is the most common aetiology for amputation.

Conclusions: Potential solutions to solving the prosthetic shortage will involve making prostheses more affordable, integrating the orthopaedic prosthesis workshop earlier in the provision process, improving surgical education and communication between providers, and working to prevent road trauma.

Keywords: Prosthesis, Amputee, Access, Barrier, Tanzania