Identifying barriers to accessing health care for chronic wounds in the Khayelitsha sub-district: A mixed-methods study

Abstract

A chronic wound can be defined as a skin defect that has not healed within three months and has an immense physical, psychological, and financial impact on individuals and their caregivers. Chronic pain, reduced mobility, emotional distress, social isolation, loss of income, and amputation-related disabilities from chronic wounds, all lead to a diminished quality of life. A massive burden is placed on the healthcare system by chronic wounds. Chronic wound care is labour intense requiring frequent wound care visits over a period of months to years. The human resources and dressing consumables needed make it a costly condition to treat. Majority of chronic wound care is provided by nurses at primary level facilities. However, if wounds are poorly managed due to a lack of resources, services, or inappropriate referrals, there is an increased risk of ongoing complications. The successful management of a chronic wound requires a well-functioning and robust healthcare system which includes adequate services, resources, and referral pathways for chronic wound care. Access to care is a complex pathway and is affected by multiple factors. Delays in accessing health care can be categorized using the Four Delays Framework which outlines delays in seeking care, reaching care, receiving care, and retaining care. To assist in providing optimal care, barriers to accessing care need to be identified and addressed. The Khayelitsha health district is one of the most impoverished areas in the city and serves a population of 391 749 people. The public health care facilities that serve the Khayelitsha health district include ten primary health care clinics, one district hospital, and one tertiary hospital. In the Khayelitsha health district, there is little known regarding the existing services, resources, and referral pathways for persons with chronic wounds. This study highlights that chronic wound care is an immense, unmet need that calls for a better understanding of existing pathways to health care with the goal to identify barriers to chronic wound care and suggest solutions to strengthen the health system. One of the priority themes of the Western Cape Government (WCG) is Empowering People. This can be achieved through improving health through health systems strengthening. In order to improve the healthcare system, we must be aware of what the system offers and how effectively it functions. Only then will be able to identify barriers and propose solutions to strengthen the system as a whole. Academia plays a critical role in providing gaps in knowledge of barriers to seeking, reaching, receiving, and retaining care for chronic wounds. This situational analysis of wound care management in the Western Cape highlights barriers to accessing and providing wound care, as well as helps empower stakeholders, including patients, wound care providers, and community members to take ownership of their role in wound care pathway. Access to care for persons with chronic wounds living in the Khayelitsha health district and the barriers faced are not known. By understanding the available services, resources, and referral pathways for chronic wound care, the barriers and gaps can be identified easier. After identifying barriers, possible solutions and recommendations will be made that in turn would assists in providing optimal care and lead to better clinical outcomes and improved patient quality of life.