Challenges and enablers in accessing paediatric inguinal hernia surgical care in Sierra Leone: a qualitative exploratory study

OBJECTIVE: To assess challenges and enablers in accessing paediatric inguinal hernia surgical care at governmental hospitals in Sierra Leone. METHODOLOGY: A qualitative exploratory interview study was conducted using semistructured interviews with 16 healthcare providers and 19 guardians of 17 children at four governmental secondary-level and tertiary-level hospitals in Sierra Leone. All interviews were analysed using thematic analysis within a constructivist paradigm, with subsequent framework-based interpretation using the WHO health system building blocks. RESULTS: The study identified five interrelated themes describing barriers to accessing surgical care across household and health system levels: (1) access to equipment, consumables and medicines; (2) health-seeking behaviour; (3) financial considerations; (4) workforce; and (5) management and hospital structure. These themes illustrate how health system constraints and household-level barriers interact to delay or impede access to surgery. Key enablers included task-sharing within the surgical workforce, community trust and financial protection through the Free Healthcare Initiative or non-governmental organisations. CONCLUSION: Access to paediatric inguinal hernia surgery in Sierra Leone is hindered by economic barriers, limited awareness and shortages of staff, equipment and medicines. Targeted community outreach, expansion of the Free Healthcare Initiative beyond age 5 and securing dedicated paediatric surgical instrument sets emerged as feasible strategies to reduce delays and improve equity of care.