Barriers to accessing appendectomy in the public sector health system in the Western Cape Province, South Africa.

Background: Appendectomy is the surgical treatment for acute appendicitis and barriers to timely care can lead to morbidity and mortality. In South Africa, patients experience delays during the stages of seeking, reaching, and receiving care. This study explored the perceptions and experiences of barriers to accessing appendectomy among patients, caregivers, and surgeons employed at selected public hospitals in the Western Cape, South Africa. Methods: A qualitative study was conducted through semi-structured in-depth interviews. Study sites comprised four public hospitals. The interviews were audio recorded, transcribed, and translated verbatim. Excerpts in the qualitative data were systematically categorised and themes were generated using inductive thematic analysis according to Braun and Clarke's methodology. Findings: The following themes were generated from the analysis 1) barriers related to late presentation to a healthcare facility and 2) barriers related to healthcare facility delays. Identified barriers were perceptions of appendicitis-like symptoms, the influence of beliefs, customs and culture on healthcare-seeking behaviour, personal and social positions and values, lack of knowledge of the health system, transport accessibility and affordability, delayed ambulance response time, and proximity of healthcare facilities. Key barriers experienced after presentation to a healthcare facility related to inter-facility transfers, surgical capacity, and the diagnostic and management capabilities of facilities. Conclusion: Participants in the study experienced, and perceived similar delays to accessing appendectomy to that reported in other African countries. Improved health literacy in communities could lead to timely healthcare-seeking behaviour for appendicitis and other emergency conditions. Efforts are needed to ensure access to affordable and available transport options, and healthcare facilities need to be better equipped to diagnose and treat appendicitis. This can be achieved through upskilling and augmenting human and other resources, which will require the support of the government and other relevant stakeholders.