Exploring the Relationship Between Surgical Capacity and Output in Ghana: Current Capacity Assessments May Not Tell the Whole Story

Stewart, Barclay T; Gyedu, Adam; Gaskill, Cameron; Boakye, Godfred; Quansah, Robert; Donkor, Peter; Volmink, Jimmy; Mock, Charles

doi:10.1007/s00268-018-4589-7

Cited by 8 publications

(6 citation statements)

References 48 publications

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“…Responses were rated as: 1, 0–25 per cent or never available; 2, 26–75 per cent or sometimes available; or 3, 76–100 per cent or always available. This system matched with previous reporting of surgical capacity assessments.…”

Section: Methodsmentioning

confidence: 84%

Mixed-methods assessment of surgical capacity in two regions in Ethiopia

Iverson

Garringer

Ahearn

et al. 2019

British Journal of Surgery

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Background Surgery is among the most neglected parts of healthcare systems in low‐ and middle‐income countries. Ethiopia has launched a national strategic plan to address challenges in the surgical system. This study aimed to assess surgical capacity in two Ethiopian regions to inform priority areas for improvement. Methods A mixed‐methods study was conducted using two tools adapted from the Lancet Commission's Surgical Assessment Tools: a quantitative Hospital Assessment Tool and a qualitative semistructured interview tool. Fifteen hospitals selected by the Federal Ministry of Health were surveyed in the Tigray and Amhara regions to assess the surgical system across five domains: service delivery, infrastructure, workforce, information management and financing. Results Service delivery was low across hospitals with a mean(s.d.) of 5(6) surgical cases per week and a narrow range of procedures performed. Hospitals reported varying availability of basic infrastructure, including constant availability of electricity (9 of 15) and running water (5 of 15). Unavailable or broken diagnostic equipment was also common. The majority of surgical and anaesthesia services were provided by non‐physician clinicians, with little continuing education available. All hospitals tracked patient‐level data regularly and eight of 15 hospitals reported surgical volume data during the assessment, but research activities were limited. Hospital financing specified for surgery was rare and the majority of patients must pay out of pocket for care. Conclusion Results from this study will inform programmes to simultaneously improve each of the health system domains in Ethiopia; this is required if better access to and quality of surgery, anaesthesia and obstetric services are to be achieved.

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Section: Methodsmentioning

confidence: 84%

Mixed-methods assessment of surgical capacity in two regions in Ethiopia

Iverson

Garringer

Ahearn

et al. 2019

British Journal of Surgery

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“…Another striking aspect was the low availability of surgical personnel, which was closely linked with surgical volumes in the regression analysis. Surgical human resources have also been identified as key drivers of surgical volumes in Ghana and Uganda 9,10 . Expansion of the surgical workforce through task-sharing to non-specialists has been applied in many low-income settings 33 , and may be a strategy for bridging the gap to higher operative volumes 6 .…”

Section: Discussionmentioning

confidence: 99%

“…Lack of human resources has been highlighted as a main barrier to surgical care 8 . Recent studies 9,10 have demonstrated human resources to be decisive drivers of surgical volumes. In addition, surgical infrastructure assessments are considered valuable tools in quantifying infrastructural needs 11 , although it is not obvious what role infrastructure assessments should play as the relationship between surgical infrastructure and operative volume has been questioned 9 .…”

Section: Introductionmentioning

confidence: 99%

“…Recent studies 9,10 have demonstrated human resources to be decisive drivers of surgical volumes. In addition, surgical infrastructure assessments are considered valuable tools in quantifying infrastructural needs 11 , although it is not obvious what role infrastructure assessments should play as the relationship between surgical infrastructure and operative volume has been questioned 9 . Facility assessments of surgical capacity, including evaluations of equipment and surgical providers, have recently been highlighted as a leading research priority to decrease perioperative mortality in Africa 12 .…”

Section: Introductionmentioning

confidence: 99%

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Impact of surgical infrastructure and personnel on volume and availability of essential surgical procedures in Liberia

et al. 2020

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Background: Essential surgical procedures rank among the most cost-effective of all healthcare interventions. The aim of this study was to enumerate surgical volumes in Liberia, quantify surgical infrastructure, personnel and availability of essential surgical procedures, describe surgical facilities, and assess the influence of human resources and infrastructure on surgical volumes. Methods: An observational countrywide survey was done in Liberia between 20 September and 8 November 2018. All healthcare facilities performing surgical procedures requiring general, regional or local anaesthesia in an operating theatre between September 2017 and August 2018 were eligible for inclusion. Information on facility infrastructure and human resources was collected by interviewing key personnel. Data on surgical volumes were extracted from operating theatre log books. Results: Of 70 healthcare facilities initially identified as possible surgical facilities, 52 confirmed operative capacity and were eligible for inclusion; all but one shared surgical data. A national surgical volume of 462 operations per 100 000 population was estimated. The median hospital offered nine of 26 essential surgical procedures. Unequal distributions of surgical infrastructure, personnel, and essential surgical procedures were identified between facilities. In multivariable regression analysis, surgical human resources (= 0⋅60, 95 per cent c.i. 0⋅34 to 0⋅87; P < 0⋅001) and infrastructure (= 0⋅03, 0⋅02 to 0⋅04; P < 0⋅001) were found to be strongly associated with operative volumes. Conclusion: The availability of essential surgical procedures in Liberia is extremely low. Descriptive tools can quantify inequalities, guide resource allocation, and highlight rational investment areas.

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“…Although tools exist to assess surgical capacity in LMICs, evidence shows that existing tools do not accurately reflect surgical health systems and output [13]. The Surgeon OverSeas' Personnel Infrastructure Procedures Equipment and Supplies tool (hereafter referred to as ''PIPES''), a modification of the World Health Organization's (WHO) Integrated Management of Emergency and Essential Surgical Care (IMEESC) toolkit, has gained prominence as a surgical capacity assessment tool for LMICs [14,15].…”

Section: Introductionmentioning

confidence: 99%

Identifying Information Gaps in a Surgical Capacity Assessment Tool for Developing Countries: A Methodological Triangulation Approach

et al. 2019

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Background Surgical capacity assessment in low-and middle-income countries (LMICs) is challenging. The Surgeon OverSeas' Personnel Infrastructure Procedure Equipment and Supplies (PIPES) survey tool has been proposed to address this challenge. There is a need to examine the gaps in veracity and context appropriateness of the information obtained using the PIPES tool. Methods We performed a methodological triangulation by comparing and contrasting information obtained using the PIPES tool with information obtained simultaneously via three other methods: time and motion study (T&M); provider focus group discussions (FGDs); and a retrospective review of hospital records. Results In its native state, the PIPES survey does not capture the role of non-physician clinicians who contribute immensely to surgical care delivery in LMICs. The surgical workforce was more accurately captured by the FGDs and T&M. It may also not reflect the improvisations (e.g., patients sharing beds, partitioning the operating theater, and using preoperative rooms for surgery, etc.) that occur to expand surgical capacity to overcome the limited infrastructure and equipment. Conclusions The PIPES tool captures vital surgical capacity information but has gaps that can be filled by modifying the tool and/or using ancillary methodologies. The interests of the researcher and the local stakeholders' perspectives should inform such modifications.

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Exploring the Relationship Between Surgical Capacity and Output in Ghana: Current Capacity Assessments May Not Tell the Whole Story

Cited by 8 publications

References 48 publications

Mixed-methods assessment of surgical capacity in two regions in Ethiopia

Mixed-methods assessment of surgical capacity in two regions in Ethiopia

Impact of surgical infrastructure and personnel on volume and availability of essential surgical procedures in Liberia

Identifying Information Gaps in a Surgical Capacity Assessment Tool for Developing Countries: A Methodological Triangulation Approach

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