Human Resource and Funding Constraints for Essential Surgery in District Hospitals in Africa: A Retrospective Cross-Sectional Survey
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Date
2010
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PLoS medicine
Abstract
Background:There is a growing recognition that the provision of surgical services in low-income countries is inadequate tothe need. While constrained health budgets and health worker shortages have been blamed for the low rates of surgery,there has been little empirical data on the providers of surgery and cost of surgical services in Africa. This study describedthe range of providers of surgical care and anesthesia and estimated the resources dedicated to surgery at district hospitalsin three African countries.
Methods and Findings:We conducted a retrospective cross-sectional survey of data from eight district hospitals inMozambique, Tanzania, and Uganda. There were no specialist surgeons or anesthetists in any of the hospitals. Most of thehealth workers were nurses (77.5%), followed by mid-level providers (MLPs) not trained to provide surgical care (7.8%), andMLPs trained to perform surgical procedures (3.8%). There were one to six medical doctors per hospital (4.2% of clinicalstaff). Most major surgical procedures were performed by doctors (54.6%), however over one-third (35.9%) were done byMLPs. Anesthesia was mainly provided by nurses (39.4%). Most of the hospital expenditure was related to staffing. Of thetotal operating costs, only 7% to 14% was allocated to surgical care, the majority of which was for obstetric surgery. Thesecosts represent a per capita expenditure on surgery ranging from US$0.05 to US$0.14 between the eight hospitals.
Conclusion:African countries have adopted different policies to ensure the provision of surgical care in their respectivedistrict hospitals. Overall, the surgical output per capita was very low, reflecting low staffing ratios and limited expendituresfor surgery. We found that most surgical and anesthesia services in the three countries in the study were provided bygeneralist doctors, MLPs, and nurses. Although more information is needed to estimate unmet need for surgery, increasingthe funds allocated to surgery, and, in the absence of trained doctors and surgeons, formalizing the training of MLPsappears to be a pragmatic and cost-effective way to make basic surgical services available in underserved areas.
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Keywords
Human Resource, EssentialSurgery, District Hospitals in Africa
Citation
Kruk, M.E., Wladis, A., Mbembati, N., Ndao-Brumblay, S.K., Hsia, R.Y., Galukande, M., Luboga, S., Matovu, A., de Miranda, H., Ozgediz, D. and Quiñones, A.R., 2010. Human resource and funding constraints for essential surgery in district hospitals in Africa: a retrospective cross-sectional survey. PLoS medicine, 7(3).