Objective To assess challenges and enablers in accessing paediatric inguinal hernia surgical care at governmental hospitals in Sierra Leone. Methodology A qualitative exploratory interview study was conducted using semistructured interviews with 16 healthcare providers and 19 guardians of 17 children at four governmental secondary-level and tertiary-level hospitals in Sierra Leone.
All interviews were analysed using thematic analysis within a constructivist paradigm, with subsequent framework-based interpretation using the WHO health system building blocks. Results The study identified five interrelated themes describing barriers to accessing surgical care across household and health system levels: (1) access to equipment, consumables and medicines; (2) health-seeking behaviour; (3) financial considerations; (4) workforce; and (5) management and hospital structure.
These themes illustrate how health system constraints and household-level barriers interact to delay or impede access to surgery. Key enablers included task-sharing within the surgical workforce, community trust and financial protection through the Free Healthcare Initiative or non-governmental organisations.
Conclusion Access to paediatric inguinal hernia surgery in Sierra Leone is hindered by economic barriers, limited awareness and shortages of staff, equipment and medicines.
BMJ Open published a clinical update in Research Highlights on 07 May 2026.
The item focuses on Challenges and enablers in accessing paediatric inguinal hernia surgical care in Sierra Leone: a qualitative exploratory study.
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