title: Strategic Assessment of Trauma Care Capacity in Ghana.
abstract: BACKGROUND
  This study aimed to assess availability of trauma care technology in Ghana. In addition, factors contributing to deficiencies were evaluated. By doing so, potential solutions to inefficient aspects of health systems management and maladapted technology for trauma care in low- and middle-income countries (LMICs) could be identified.
  
  
  METHODS
  Thirty-two items were selected from the World Health Organization's Guidelines for Essential Trauma Care. Direct inspection and structured interviews with administrative, clinical, and biomedical engineering staff were used to assess the challenges and successes of item availability at 40 purposively sampled district, regional, and tertiary hospitals.
  
  
  RESULTS
  Hospital assessments demonstrated marked deficiencies. Some of these were low cost, such as basic airway supplies, chest tubes, and cervical collars. Item non-availability resulted from several contributing factors, namely equipment absence, lack of training, frequent stock-outs, and technology breakage. A number of root causes for these factors were identified, including ineffective healthcare financing by way of untimely national insurance reimbursements, procurement and stock-management practices, and critical gaps in local biomedical engineering and trauma care training. Nonetheless, local examples of successfully overcoming deficiencies were identified (e.g., public-private partnering, ensuring company engineers trained technicians on-the-job during technology installation or servicing).
  
  
  CONCLUSIONS
  While availability of several low-cost items could be better supplied by improvements in stock-management and procurement policies, there is a critical need for redress of the national insurance reimbursement system and trauma care training of district hospital staff. Further, developing local service and technical support capabilities is more and more pressing as technology plays an increasingly important role in LMIC healthcare systems.
authors.affiliation: Department of Surgery, University of Washington, 1959 NE Pacific St., Suite BB-487, PO Box 356410, Seattle, WA, 98195-6410, USA, stewarb@uw.edu.
authors.forename: Barclay T
authors.initials: BT
authors.lastname: Stewart
authors.forename: Robert
authors.initials: R
authors.lastname: Quansah
authors.forename: Adam
authors.initials: A
authors.lastname: Gyedu
authors.forename: James
authors.initials: J
authors.lastname: Ankomah
authors.forename: Peter
authors.initials: P
authors.lastname: Donkor
authors.forename: Charles
authors.initials: C
authors.lastname: Mock
mesh_terms: D002983:Clinical Competence; D003695:Delivery of Health Care; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000592:standards; D004865:Equipment and Supplies, Hospital / Q000600:supply & distribution; D005869:Ghana; D061889:Healthcare Financing; D006767:Hospitals, District / Q000458:organization & administration / Q000592:standards; D006801:Humans; D010564:Personnel, Hospital / Q000592:standards; D011203:Poverty; D062606:Tertiary Care Centers / Q000458:organization & administration / Q000592:standards; D014194:Traumatology / Q000295:instrumentation / Q000458:organization & administration* / Q000592:standards