Barriers to increase surgical productivity in Sierra Leone: a qualitative study

Abstract

ObjectiveTo explore factors influencing surgical provider productivity and identify barriers against and opportunities to increase individual surgical productivity in Sierra Leone, in order to explain the observed increase in unmet surgical need from 92.2% to 92.7% and the decrease in surgical productivity to 1.7 surgical procedures per provider per week between 2012 and 2017.Design and methodsThis explanatory qualitative study consisted of in-depth interviews about factors influencing surgical productivity in Sierra Leone. Interviews were analysed with a thematic network analysis and used to develop a conceptual framework.Participants and setting21 surgical providers and hospital managers working in 12 public and private non-profit hospitals in all regions in Sierra Leone.ResultsSurgical providers in Sierra Leone experience a broad range of factors within and outside the health system that influence their productivity. The main barriers involve both patient and facility financial constraints, lack of equipment and supplies, weak regulation of providers and facilities and a small surgical workforce, which experiences a lack of recognition. Initiation of a Free Health Care Initiative for obstetric and paediatric care, collaborations with partners or non-governmental organisations, and increased training opportunities for highly motivated surgical providers are identified as opportunities to increase productivity.DiscussionBroader nationwide health system strengthening is required to facilitate an increase in surgical productivity and meet surgical needs in Sierra Leone. Development of a national strategy for surgery, obstetrics and anaesthesia, including methods to reduce financial barriers for patients, improve supply-mechanisms and expand training opportunities for new and established surgical providers can increase surgical capacity. Establishment of legal frameworks and appropriate remuneration are crucial for sustainability and retention of surgical health workers.

Global Ophthalmic Health Initiatives in Ebola and Emerging Infectious Disease Outbreaks: Implications for Vision Health Systems, Program Implementation, and Disease Surveillance

“…Prior evaluation of emergency care capacity in Freetown, Sierra Leone has revealed widespread deficiencies in domains including infrastructure, guidelines for critical care, systems, and training. [28][29][30] There is also a reported shortage of medical personnel exacerbated by the aftermath of the EVD outbreak, which led to the deaths of 21% of Sierra Leone's health workforce. 31 Moreover, the paucity of supportive care and medical countermeasures during the response to the West Africa outbreak differ from the clinical trials and compassionate use protocols utilized in more recent outbreaks in the DRC.…”

“…The explanations for these stark differences in mortality reported in West Africa are multifactorial and parallel the vision health outcomes observed in assessments of EVD survivors. Prior evaluation of emergency care capacity in Freetown, Sierra Leone has revealed widespread deficiencies in domains including infrastructure, guidelines for critical care, systems, and training 28–30. There is also a reported shortage of medical personnel exacerbated by the aftermath of the EVD outbreak, which led to the deaths of 21% of Sierra Leone’s health workforce 31.…”

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“…Over the years, there have been efforts to overcome different barriers in the field of medicine that are caused by natural human limitations and those that relate to the shortage of medical practitioners, such as surgeons [1] and the geographical barriers that limit access to quality healthcare services in particular areas [2][3][4] . In this regard, science and technology have been applied to provide solutions that improve the quality of healthcare and its access throughout the globe, which is one area of medicine that has been the center of focus in the field of surgery [5] .…”