Healthcare provider and patient perspectives on barriers and facilitators to accessing maxillofacial injury care in Lesotho: a qualitative study
- 1Public Health Medicine, School of Medicine, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
- 2Allied Health Sciences, Lesotho School of Medicine at National Health Training College, Maseru, Lesotho
- 3Cancer and Infectious Diseases Epidemiology Research Unit (CIDERU), University of KwaZulu-Natal, Durban, South Africa
Abstract
Objectives: Maxillofacial injuries encompass a wide spectrum of trauma to the face and jaws, with facial fractures forming a major component. Between 1990 and 2017, the global incidence and prevalence of facial fractures increased by 39.45% and 54.39%, respectively, carrying severe risks. In sub-Saharan Africa, healthcare gaps cause significant under-reporting of maxillofacial injuries. Systemic barriers in low-resource settings hinder coordination. This study explored the barriers and facilitators to accessing maxillofacial injury services in Lesotho from both healthcare provider and patient perspectives.
Design: This qualitative study, guided by grounded theory, used in-depth interviews with healthcare providers and patients in Lesotho. The data were analysed thematically using NVivo V.14 software. The process followed Standards for Reporting Qualitative Research (SRQR) reporting guidelines.
Setting: This study was conducted across key maxillofacial care departments, dental clinics, emergency units and surgical wards in three strategically selected facilities in Lesotho. These comprised two secondary-level district hospitals (north and south) and the country’s sole tertiary-level surgical referral hospital in the capital, Maseru, ensuring broad population coverage and accessibility.
Participants: This study employed purposive sampling of healthcare providers with at least 4 years of injury management experience from various disciplines, alongside patients who accessed maxillofacial services. Recruitment occurred from November 2023 to April 2024 across the three healthcare facilities.
Results: In-depth interviews identified systemic barriers to maxillofacial care in Lesotho across four domains: access, referrals, treatment and care and maxillofacial injury preventive measures. Participants viewed the availability of ambulances and subsidised medical fees as insufficient, with some participants expecting services to be entirely free. Other systemic issues identified included fragmented communication from absent referral protocols, restricted access, severe resource constraints, shortages of healthcare professionals and inadequate emergency and diagnostic services. These inefficiencies emerged as interconnected factors that participants perceived to be undermining injury management across Lesotho’s health system.
Conclusion: Participants viewed systemic inefficiencies, poor referral protocols, limited access and resource shortages as adversely affecting maxillofacial injury care in Lesotho. Future implementation could integrate trauma care into national frameworks, support specialised expertise and resources and expand education for healthcare workers and the public. Evaluating this approach may help address barriers, improve injury management and strengthen healthcare system resilience.
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BibTeX
@article{adeleke2026healthcare,
title = {{Healthcare provider and patient perspectives on barriers and facilitators to accessing maxillofacial injury care in Lesotho: a qualitative study}},
author = {Adekunle Isaac Adeleke and Khumbulani Hlongwana and Themba Ginindza},
journal = {BMJ Open},
year = {2026},
month = oct,
doi = {10.1136/bmjopen-2026-117215},
url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-117215},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Healthcare provider and patient perspectives on barriers and facilitators to accessing maxillofacial injury care in Lesotho: a qualitative study
AU - Adekunle Isaac Adeleke
AU - Khumbulani Hlongwana
AU - Themba Ginindza
PY - 2026
DA - 2026/10/30
JO - BMJ Open
DO - 10.1136/bmjopen-2026-117215
UR - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-117215
AB - Objectives: Maxillofacial injuries encompass a wide spectrum of trauma to the face and jaws, with facial fractures forming a major component. Between 1990 and 2017, the global incidence and prevalence of facial fractures increased by 39.45% and 54.39%, respectively, carrying severe risks. In sub-Saharan Africa, healthcare gaps cause significant under-reporting of maxillofacial injuries. Systemic barriers in low-resource settings hinder coordination. This study explored the barriers and facilitators to accessing maxillofacial injury services in Lesotho from both healthcare provider and patient perspectives. Design: This qualitative study, guided by grounded theory, used in-depth interviews with healthcare providers and patients in Lesotho. The data were analysed thematically using NVivo V.14 software. The process followed Standards for Reporting Qualitative Research (SRQR) reporting guidelines. Setting: This study was conducted across key maxillofacial care departments, dental clinics, emergency units and surgical wards in three strategically selected facilities in Lesotho. These comprised two secondary-level district hospitals (north and south) and the country’s sole tertiary-level surgical referral hospital in the capital, Maseru, ensuring broad population coverage and accessibility. Participants: This study employed purposive sampling of healthcare providers with at least 4 years of injury management experience from various disciplines, alongside patients who accessed maxillofacial services. Recruitment occurred from November 2023 to April 2024 across the three healthcare facilities. Results: In-depth interviews identified systemic barriers to maxillofacial care in Lesotho across four domains: access, referrals, treatment and care and maxillofacial injury preventive measures. Participants viewed the availability of ambulances and subsidised medical fees as insufficient, with some participants expecting services to be entirely free. Other systemic issues identified included fragmented communication from absent referral protocols, restricted access, severe resource constraints, shortages of healthcare professionals and inadequate emergency and diagnostic services. These inefficiencies emerged as interconnected factors that participants perceived to be undermining injury management across Lesotho’s health system. Conclusion: Participants viewed systemic inefficiencies, poor referral protocols, limited access and resource shortages as adversely affecting maxillofacial injury care in Lesotho. Future implementation could integrate trauma care into national frameworks, support specialised expertise and resources and expand education for healthcare workers and the public. Evaluating this approach may help address barriers, improve injury management and strengthen healthcare system resilience.
SN - 2044-6055
SN - 2044-6055
ER -