61.21 Perceptions on quality of care: results from a qualitative assessment, Nyarugusu refugee camp

Z. O. Enumah1,2, H. Ngude3, E. W. Etchill1, K. A. Stevens1,2, P. Winch2  1Johns Hopkins University School Of Medicine,Surgery,Baltimore, MD, USA 2Johns Hopkins School of Public Health,International Health,Baltimore, MD, USA 3Tanzanian Red Cross Society,Nyarugusu, KIGOMA, Tanzania

Introduction:  An estimated 5 billion people do not have access to safe and affordable surgery and anesthesia. There is an estimated need of 143 million operations in low and middle-income countries (LMIC). Healthcare in refugee settings remains unreliable, and there is little evidence on refugee perceptions of the care that is offered. This study is a participatory assessment of healthcare services available to refugees in a large refugee camp.

This study took place in the Nyaragusu refugee camp, a large refugee camp in Tanzania with a population of approximately 150,000 people. Qualitative research methods were employed, including a participatory assessment based on key informant interviews and focus group discussions. Additionally, available local literature was analyzed. Fieldwork was conducted at various time points from 2011-2017.  Field notes were recorded, and interviews and focus group were audio recorded, translated and transcribed to English from Kiswahili. Nvivo qualitative software was utilized to analyze the data.

Six key informant interviews and seven focus groups were conducted reaching a population of approximately 75 individuals. General promoters and barriers to care were assessed and include free healthcare services including surgical services, access to mosquito nets, blankets, and condoms. Approximately 600+ outpatient visits occur each day. Refugee healthcare educators comprise the health information team (HIT) in the camp and are a positive service. Barriers include poor payment for these refugee health educators, long wait times at health centers, lack of access to basic medications and strained doctor-patient relationships.

This study is a participatory assessment of healthcare services available to refugees in Nyarugusu refugee camp. In general, there are major promoters and barriers to accessibility and quality of care in Nyarugusu perceived by refugees and healthcare staff. This study paves the way for the development of meaningful intervention.