Access to reverse shoulder arthroplasty in South Africa’s public healthcare system

Abstract

Background: Access to healthcare services, particularly surgical interventions, remains a critical challenge in low- to middle-income countries (LMICs). Reverse shoulder arthroplasty (RSA) is the most frequently performed arthroplasty procedure of the shoulder and is recommended for the treatment of complex shoulder conditions in the elderly population. This study investigated the availability and accessibility of RSA within South Africa’s public healthcare system, focusing on equity in surgical care provision.

Methods: Using a multifaceted research approach, data were collected from 33 professionals across eight provinces, representing a significant proportion of the population.

Results: Results indicate significant disparities in access to RSA, with urban areas and tertiary hospitals having better resources and capacity. The majority of the tertiary level hospitals are easily accessible to urban compared to rural dwellers. Despite the growing need for RSA, particularly among older demographics, the study reveals a scarcity of skilled shoulder surgeons and inadequate infrastructure, especially in rural regions.

Conclusion: These findings underscore systemic barriers hindering equitable access to RSA and surgical care in South Africa. Recommendations include increasing resources for training, improving infrastructure, and enhancing referral systems to address these disparities and ensure universal access to essential surgical services.

Level of evidence: 4