title: Orthopaedic Trauma Care Capacity Assessment and Strategic Planning in Ghana: Mapping a Way Forward.
abstract: BACKGROUND
  Orthopaedic conditions incur more than 52 million disability-adjusted life years annually worldwide. This burden disproportionately affects low and middle-income countries, which are least equipped to provide orthopaedic care. We aimed to assess orthopaedic capacity in Ghana, describe spatial access to orthopaedic care, and identify hospitals that would most improve access to care if their capacity was improved.
  
  
  METHODS
  Seventeen perioperative and orthopaedic trauma care-related items were selected from the World Health Organization's Guidelines for Essential Trauma Care. Direct inspection and structured interviews with hospital staff were used to assess resource availability and factors contributing to deficiencies at 40 purposively sampled facilities. Cost-distance analyses described population-level spatial access to orthopaedic trauma care. Facilities for targeted capability improvement were identified through location-allocation modeling.
  
  
  RESULTS
  Orthopaedic trauma care assessment demonstrated marked deficiencies. Some deficient resources were low cost (e.g., spinal immobilization, closed reduction capabilities, and prosthetics for amputees). Resource nonavailability resulted from several contributing factors (e.g., absence of equipment, technology breakage, lack of training). Implants were commonly prohibitively expensive. Building basic orthopaedic care capacity at 15 hospitals without such capacity would improve spatial access to basic care from 74.9% to 83.0% of the population (uncertainty interval [UI] of 81.2% to 83.6%), providing access for an additional 2,169,714 Ghanaians.
  
  
  CONCLUSIONS
  The availability of several low-cost resources could be better supplied by improvements in organization and training for orthopaedic trauma care. There is a critical need to advocate and provide funding for orthopaedic resources. These initiatives might be particularly effective if aimed at hospitals that could provide care to a large proportion of the population.
authors.affiliation: 1Departments of Surgery (B.T.S. and C.M.) and Global Health (C.M.), University of Washington, Seattle, Washington 2School of Public Health (B.T.S.) and Department of Surgery (A.G., D.Y., and R.Q.), School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana 3Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana 4Department of Interdisciplinary Health Sciences, Stellenbosch University, Cape Town, South Africa 5Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada 6Department of Surgery, Eastern Regional Hospital, Koforidua, Ghana 7Harborview Injury Prevention & Research Center, Seattle, Washington 8Eastern Regional Health Directorate, Ghana Health Service, Ministry of Health, Koforidua, Ghana 9St. Joseph Orthopaedic Hospital, Korforidua, Ghana.
authors.forename: Barclay T
authors.initials: BT
authors.lastname: Stewart
authors.forename: Adam
authors.initials: A
authors.lastname: Gyedu
authors.forename: Gavin
authors.initials: G
authors.lastname: Tansley
authors.forename: Dominic
authors.initials: D
authors.lastname: Yeboah
authors.forename: Forster
authors.initials: F
authors.lastname: Amponsah-Manu
authors.forename: Charles
authors.initials: C
authors.lastname: Mock
authors.forename: Wilfred
authors.initials: W
authors.lastname: Labi-Addo
authors.forename: Robert
authors.initials: R
authors.lastname: Quansah
mesh_terms: D057191:Capacity Building / Q000458:organization & administration* / Q000706:statistics & numerical data; D005869:Ghana / Q000453:epidemiology; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D009985:Orthopedics / Q000458:organization & administration* / Q000706:statistics & numerical data*; D010348:Patient Care Team / Q000458:organization & administration / Q000706:statistics & numerical data; D000070318:Strategic Planning / Q000706:statistics & numerical data; D014193:Trauma Centers / Q000458:organization & administration* / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000628:therapy