Examining the patient- and system-related forces influencing the responsiveness of hip fracture care in Zimbabwe: Findings from an ethnographic study

Rapidly rising longevity and the projected increase in fractures among older adults in Southern Africa underscores the necessity to strengthen healthcare systems in the region. Delivering orthopaedic care to older people within a multi-disciplinary framework is widely recommended. This ethnographic study sought to examine the responsiveness of hip fracture care in Zimbabwe and the influence of patient- and system-related forces We used ethnographic methods to examine the experiences of patients and caregivers and characterise hip fracture care provision. Case studies were undertaken with 40 patients (22 male, 18 female) and 33 caregivers (6 male, 27 female), including family members and friends. These data were complemented by interviews and observations of clinical practice with 42 healthcare professionals (23 female, 19 male) involved in the delivery of hip fracture services, including orthopaedic surgeons, physicians and physiotherapists. Participants were purposively sampled from six hospitals providing hip fracture care across Northern Zimbabwe. Snowball sampling was also used to recruit additional study participants. Data were analysed using an abductive analytical approach. Patients’ and caregivers’ experiences revealed lengthy hospital stays, poor communication concerning diagnosis and treatment, undignified continence management, and limited access to social support. Patients’ experiences highlighted the importance of access to pain relief medication, and the impact of unaffordable care – elements distinct from those within current responsiveness frameworks. Health professionals explained how resource constraints, understaffing, and changes in pain management processes impacted their ability to meet patients’ needs. Yet, their narratives told of the various actions they employed to circumvent health system constraints and respond to patient priorities. Considering these findings, we highlight key considerations for health systems responsiveness, including considering the role of socioeconomic factors. We also propose practical recommendations for improving responsive hip fracture care in Zimbabwe, such as developing guidelines for patient optimisation and standardisation of hip implant costs.