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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Human resource and funding constraints for essential surgery in district hospitals in africa: A retrospective cross-sectional survey
PLoS Medicine, Volume 7, No. 3, Year 2010
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Description
Background There is a growing recognition that the provision of surgical services in low-income countries is inadequate to the 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 described the range of providers of surgical care and anesthesia and estimated the resources dedicated to surgery at district hospitals in three African countries. Methods and Findings We conducted a retrospective cross-sectional survey of data from eight district hospitals in Mozambique, Tanzania, and Uganda. There were no specialist surgeons or anesthetists in any of the hospitals. Most of the health workers were nurses (77.5%), followed by mid-level providers (MLPs) not trained to provide surgical care (7.8%), and MLPs trained to perform surgical procedures (3.8%). There were one to six medical doctors per hospital (4.2% of clinical staff). Most major surgical procedures were performed by doctors (54.6%), however over one-third (35.9%) were done by MLPs. Anesthesia was mainly provided by nurses (39.4%). Most of the hospital expenditure was related to staffing. Of the total operating costs, only 7% to 14% was allocated to surgical care, the majority of which was for obstetric surgery. These costs 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 respective district hospitals. Overall, the surgical output per capita was very low, reflecting low staffing ratios and limited expenditures for surgery. We found that most surgical and anesthesia services in the three countries in the study were provided by generalist doctors, MLPs, and nurses. Although more information is needed to estimate unmet need for surgery, increasing the funds allocated to surgery, and, in the absence of trained doctors and surgeons, formalizing the training of MLPs appears to be a pragmatic and cost-effective way to make basic surgical services available in underserved areas. © 2010 Kruk et al.
Authors & Co-Authors
Kruk, Margaret Elizabeth
United States, New York
Mailman School of Public Health
Wladis, Andreas
Sweden, Stockholm
Södersjukhuset
Mbembati, Naboth A.A.
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Ndao-Brumblay, S. Khady
United States, Ann Arbor
University of Michigan School of Public Health
Hsia, Renee Yuen Jan
United States, San Francisco
University of California, San Francisco
Galukande, Moses
Uganda, Kampala
Makerere University
Luboga, Samuel Abilemech
Uganda, Kampala
Makerere University
Matovu, Alphonsus
Uganda
Kamuli Mission Hospital
de Miranda, Helder
Mozambique, Beira
Catholic University of Mozambique
Ozgediz, Doruk Erman
Canada, Toronto
Hospital for Sick Children University of Toronto
Quiñones, Ana Romàn
United States, New York
Mailman School of Public Health
Rockers, Peter C.
United States, Ann Arbor
University of Michigan, Ann Arbor
von Schreeb, Johan
Sweden, Stockholm
Karolinska Institutet
Vaz, Fernando
Mozambique, Maputo
Higher Institute of Health Sciences
Debas, Haile T.
United States, San Francisco
University of California, San Francisco
MacFarlane, Sarah B.J.
United States, San Francisco
University of California, San Francisco
Statistics
Citations: 149
Authors: 16
Affiliations: 12
Identifiers
Doi:
10.1371/journal.pmed.1000242
ISSN:
15491277
e-ISSN:
15491676
Research Areas
Health System And Policy
Maternal And Child Health
Study Design
Cross Sectional Study
Cohort Study
Study Approach
Quantitative
Study Locations
Mozambique
Tanzania
Uganda