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

Abstract

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.

Diagnosis and management of surgical disease at Ethiopian health centres: cross-sectional survey of resources and barriers to care

“…This plan which encompasses human resource and infrastructure development, data quality, service quality and monitoring and evaluation will be crucial for closing gaps in access to surgical care 14. As part of the SaLTS initiative, an evaluation of surgical hospitals in two regions, one of which encompasses this study’s HCs, revealed that access to surgical care may be limited by difficult roads and delays in transport, as well as limitations of all five basic domains of surgical care (service delivery, infrastructure, workforce, information management, financing) 27…”

“…Some studies have supported the decentralisation of surgical care to rural areas by task-shifting to non-physician surgical providers or surgical ‘camps’ to provide intermittent services 26. However given the resource limitations at primary hospitals in Ethiopia,27 this solution may not be reasonable in this setting. Additionally, the Ethiopian MOH has continued to build new hospitals and train non-physician surgical providers (IESOs) in the interim, therefore some of these delays may be expected to improve, although these mid-level providers staff hospitals and usually not HCs.…”

Financing of surgery and anaesthesia in sub-Saharan Africa: a scoping review

“…Seven articles had data on revenue sources for surgery at the hospital level, with OOP payments, [18][19][20][21] government support 22 and donor funds 21 22 identified as the biggest sources of the operational funds. In Ekenze and others' systematic review of studies published between January 2007 and November 2016 that reported the specific funding of paediatric surgeries in SSA, OOP was the predominant source of funding (91.4%), followed by non-governmental organisation (NGO) funding (60%).…”

A realized vision of access to safe, affordable surgical and anaesthesia care

“…The Commission articulated a broad array of research themes, seven of which are found within the breadth of papers in this supplement including: policy, quality and safety, training and education, partnership, information management, care delivery innovation and burden. However, there are four important themes that are not covered, including cost and finance, determinants and barriers, impact of disease and prevention.…”