Changes in surgical volume, workforce, and productivity in Sierra Leone between 2012 and 2017

Lindheim-Minde, Barbro; Gjøra, Andreas; Bakker, Juul; Duinen, Alex J. van; Leerdam, Daniel van; Smalle, Isaac O; Bundu, I; Bolkan, Håkon A.

doi:10.1016/j.surg.2021.02.043

Cited by 14 publications

(26 citation statements)

References 23 publications

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“…A total of 60 hospitals were identified that performed surgery in Sierra Leone in 2017 (Figure 2), 20 of those were small private for-profit facilities with very low surgical volume and were not considered for inclusion in the current study(19). Out of the 40 eligible hospitals, 32 agreed to share data for this study, their geographic location and sector is described in table 1.…”

Section: Resultsmentioning

confidence: 99%

“…Out of the 40 eligible hospitals, 32 agreed to share data for this study, their geographic location and sector is described in table 1. In 2017, these 32 included hospitals performed 87.1% of the nationwide surgical volume(19). For the qualitative analysis we interviewed 12 staff and five patients.…”

Section: Resultsmentioning

confidence: 99%

“…Hospital inclusion flowchart. n = number; *hospitals identified as providing surgery during 2017 mapping surgical activity in Sierra Leone(19). …”

Section: Resultsmentioning

confidence: 99%

“…Hospital data was collected from January 1 s t 2020 until September 30 th 2020 by trained surgical assistant community health officers. The list of hospitals providing surgical services was sourced from a previous mapping study(19). Facilities which did not consent to data collection and facilities with known very low surgical volumes were excluded.…”

Section: Methodsmentioning

confidence: 99%

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The impact of the COVID-19 pandemic on health service utilisation in Sierra Leone

Sevalie

Youkee

et al. 2021

Preprint

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Introduction: The COVID-19 pandemic has adversely affected health systems in many countries, but little is known about effects on health systems in sub-Saharan Africa. This study examines the effects of COVID-19 on health service utilisation in a sub-Saharan country, Sierra Leone. Methods: Mixed-methods study using longitudinal nationwide hospital data (admissions, operations, deliveries and referrals), and qualitative interviews with healthcare workers and patients. Hospital data were compared across Quarters (Q) in 2020, with day 1 of Q2 representing the start of the pandemic in Sierra Leone. Admissions are reported in total and disaggregated by sex, service (surgical, medical, maternity, paediatric), and hospital type (government or private not for profit). Referrals in 2020 were compared with 2019, to assess whether any changes were the result of seasonality. Comparisons were performed using students t test. Qualitative data were analysed using thematic analysis. Results: From Q1-Q2, weekly mean hospital admissions decreased by 14.7% (p=0.005). Larger decreases were seen in male 18.8%, than female 12.5% admissions. The largest decreases were in surgical admissions, a 49.8 % decrease (p<0.001) and medical admissions, a 28.7% decrease (p=0.002). Paediatric and maternity admissions did not significantly change. Total operations decreased by 13.9% (p<0.001), whilst caesarean sections and facility-based deliveries showed significant increases, 12.7 % (p=0.014) and 7.5% (p=0.03) respectively. In Q3 total admissions remained 13.2% lower (p<0.001) than Q1. Mean weekly referrals were lower in Q2 and Q3 of 2020 compared to 2019, suggesting findings were unlikely to be seasonal. Qualitative analysis identified both supply-side factors, prioritisation of essential services, introduction of COVID-19 services and pausing elective care, and demand-side factors, fear of nosocomial infection and financial hardship. Conclusion: The study demonstrated a decrease in health service utilisation during Covid-19, the decrease is less than in other countries during COVID-19 and less than reported during the Ebola epidemic.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Hospital inclusion flowchart. n = number; *hospitals identified as providing surgery during 2017 mapping surgical activity in Sierra Leone(19). …”

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

The impact of the COVID-19 pandemic on health service utilisation in Sierra Leone

Sevalie

Youkee

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…The list of hospitals providing surgical services was sourced from a previous mapping study. 21 Facilities that did not consent to data collection and facilities with known very low surgical volumes were excluded. Data were collected from the hospital admission book, the operation theatre book and the maternity ward book.…”

Section: Methodsmentioning

confidence: 99%

The impact of the COVID-19 pandemic on hospital utilisation in Sierra Leone

et al. 2021

Self Cite

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IntroductionThe COVID-19 pandemic has adversely affected health systems in many countries, but little is known about effects on health systems in sub-Saharan Africa. This study examines the effects of COVID-19 on hospital utilisation in a sub-Saharan country, Sierra Leone.MethodsMixed-methods study using longitudinal nationwide hospital data (admissions, operations, deliveries and referrals) and qualitative interviews with healthcare workers and patients. Hospital data were compared across quarters (Q) in 2020, with day 1 of Q2 representing the start of the pandemic in Sierra Leone. Admissions are reported in total and disaggregated by sex, service (surgical, medical, maternity and paediatric) and hospital type (government or private non-profit). Referrals in 2020 were compared with 2019 to assess whether any changes were the result of seasonality. Comparisons were performed using Student’s t-test. Qualitative data were analysed using thematic analysis.ResultsFrom Q1 to Q2, weekly mean hospital admissions decreased by 14.7% (p=0.005). Larger decreases were seen in male 18.8% than female 12.5% admissions. The largest decreases were in surgical admissions, a 49.8% decrease (p<0.001) and medical admissions, a 28.7% decrease (p=0.002). Paediatric and maternity admissions did not significantly change. Total operations decreased by 13.9% (p<0.001), while caesarean sections and facility-based deliveries showed significant increases: 12.7% (p=0.014) and 7.5% (p=0.03), respectively. In Q3, total admissions remained 13.2% lower (p<0.001) than Q1. Mean weekly referrals were lower in Q2 and Q3 of 2020 compared with 2019, suggesting findings were unlikely to be seasonal. Qualitative analysis identified both supply-side factors, prioritisation of essential services, introduction of COVID-19 services and pausing elective care, and demand-side factors, fear of nosocomial infection and financial hardship.ConclusionThe study demonstrated a decrease in hospital utilisation during COVID-19, the decrease is less than reported in other countries during COVID-19 and less than reported during the Ebola epidemic.

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A Nationwide Enumeration of the Surgical Workforce, its Production and Disparities in Operative Productivity in Liberia

et al. 2021

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Background Any health care system that strives to deliver good health and well-being to its population relies on a trained workforce. The aim of this study was to enumerate surgical provider density, describe operative productivity and assess the association between key surgical system characteristics and surgical provider productivity in Liberia. Methods A nationwide survey of operation theatre logbooks, available human resources and facility infrastructure was conducted in 2018. Surgical providers were counted, and their productivity was calculated based on operative numbers and full-time equivalent positions. Results A total of 286 surgical providers were counted, of whom 67 were accredited specialists. This translated into a national density of 1.6 specialist providers per 100,000 population. Non-specialist physicians performed 58.3 percent (3607 of 6188) of all operations. Overall, surgical providers performed a median of 1.0 (IQR 0.5–2.7) operation per week, and there were large disparities in operative productivity within the workforce. Most operations (5483 of 6188) were categorized as essential, and each surgical provider performed a median of 2.0 (IQR 1.0–5.0) different types of essential procedures. Surgical providers who performed 7–14 different types of essential procedures were more than eight times as productive as providers who performed 0–1 essential procedure (operative productivity ratio = 8.66, 95% CI 6.27–11.97, P < 0.001). Conclusion The Liberian health care system struggles with an alarming combination of few surgical providers and low provider productivity. Disaggregated data can provide a high-resolution picture of local challenges that can lead to local solutions.

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Changes in surgical volume, workforce, and productivity in Sierra Leone between 2012 and 2017

Cited by 14 publications

References 23 publications

The impact of the COVID-19 pandemic on health service utilisation in Sierra Leone

The impact of the COVID-19 pandemic on health service utilisation in Sierra Leone

The impact of the COVID-19 pandemic on hospital utilisation in Sierra Leone

A Nationwide Enumeration of the Surgical Workforce, its Production and Disparities in Operative Productivity in Liberia

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