Table 1.

Barriers to surgical care and their related delays

Barrier	Delay(s)*
Lack of decentralised services	1, 2, 3, 4
Family responsibilities	1, 2, 4
Lack of social support	1, 2, 4
Experienced lack of staff empathy	1, 3, 4
Language barrier	1, 3, 4
Systemic inequities	1, 3, 4
Lack of service user’s surgical healthcare knowledge	1, 4
Lack of surgical health education	1, 4
Procrastination	1, 4
Religion/preference for alternative practitioners	1, 4
Stigma of disease	1, 4
Fear of the individual consequences of surgical care	1
Previous bad experiences	1
Wariness of healthcare system	1
Cancellation of appointments and procedures	2, 3, 4
Lack of continuity of care	2, 3, 4
Lack of funding of public healthcare system	2, 3, 4
Poor communication between service providers at different levels	2, 3, 4
Complex and disjointed referral system	2, 4
Poor road infrastructure	2, 4
Delay of diagnosis	2, 3
Problems with cost, time, safety, distance and comfort of transport	2
Difficulty with navigating the facility	3, 4
Lack of adequate service user records	3, 4
Lack of and poor maintenance of equipment	3, 4
Lack of management, referral and retention in care guidelines	3, 4
Lack of service provider’s knowledge, training and experience	3, 4
Lack of supervision for junior service providers	3, 4
Large burden of disease	3, 4
Limited surgical outreach	3, 4
Long waiting times	3, 4
Lower prioritisation of certain surgical conditions	3, 4
Limited theatre time	3
Lack of home based services	4

*Delay 1: seeking care, Delay 2: reaching care, Delay 3: receiving care, Delay 4: remaining in care.