Staff recognition and its importance for surgical service delivery: a qualitative study in Freetown, Sierra Leone

Author:

Willott Chris1,Boyd Nick12,Wurie Haja3,Smalle Isaac14,Kamara T B4,Davies Justine I567,Leather Andrew J M1

Affiliation:

1. King’s Centre for Global Health and Health Partnerships, School of Population Health & Environmental Sciences, King’s College London, Room 2.13, Weston Education Centre, Cutcombe Road, London, SE5 9RJ, UK

2. Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol BS2 8BJ, UK

3. College of Medicine and Allied Health Sciences, University of Sierra Leone, PMB, New England Ville, Freetown, Sierra Leone

4. Department of Surgery, College of Medicine and Allied Health Sciences, University of Sierra Leone, 1 Percival Street, Freetown, Sierra Leone

5. Centre for Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK

6. Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Parktown 2193, Johannesburg, South Africa

7. Centre for Global Surgery, Department of Global Health, Stellenbosch University, Tygerberg 7505, South Africa

Abstract

Abstract We examined the views of providers and users of the surgical system in Freetown, Sierra Leone on processes of care, job and service satisfaction and barriers to achieving quality and accessible care, focusing particularly on the main public tertiary hospital in Freetown and two secondary and six primary sites from which patients are referred to it. We conducted interviews with health care providers (N = 66), service users (n = 24) and people with a surgical condition who had chosen not to use the public surgical system (N = 13), plus two focus groups with health providers in primary care (N = 10 and N = 10). The overall purpose of the study was to understand perceptions on processes of and barriers to care from a variety of perspectives, to recommend interventions to improve access and quality of care as part of a larger study. Our research suggests that providers perceive their relationships with patients to be positive, while the majority of patients see the opposite: that many health workers are unapproachable and uncaring, particularly towards poorer patients who are unable or unwilling to pay staff extra in the form of informal payments for their care. Many health care providers note the importance of lack of recognition shown to them by their superiors and the health system in general. We suggest that this lack of recognition underlies poor morale, leading to poor care. Any intervention to improve the system should therefore consider staff–patient relations as a key element in its design and implementation, and ideally be led and supported by frontline healthcare workers.

Funder

National Institute for Health Research

King’s College London

UK Government

NIHR

Department of Health and Social Care

Publisher

Oxford University Press (OUP)

Subject

Health Policy

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