Potential barriers
Individual
Age
Gender
Education
Religious or cultural beliefs
Financial concerns
Direct costs (out-of-pocket expenses)
Indirect costs (time off work)
Cost of travel to health facility
Fear of anesthesia or surgery
Health system
Governance
Policies
Oversight
Regulation
Resource allocation
Service delivery
Lack of human resources
Insufficient numbers
Inadequate distribution (urban vs. rural)
Education and training
Orthopedic surgeons
Human resources
Other providers
General surgeon
General MD
Paraprofessionals
Medicines and technologies
Inadequate infrastructure
Inadequate physical resources and supplies
Inadequate mechanisms for transportation and referral
Financing
Insufficient governmental allocation of funding
Dependence on out-of-pocket expenses
No protection from catastrophic spending
No risk pooling or insurance schemes
Information
Inadequate data on the burden of orthopedic diseases (local, regional, national, global)
Inadequate information on availability of services (infrastructure, human, physical resources) at the facilities level
Lack of monitoring capability (disease burden, service availability, quality/outcomes)
Inadequate communication between central and peripheral levels of health system
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