Surgical and Trauma Capacity Assessment in Rural Haryana, India

Abstract

Background: Trauma is a major global health problem and majority of the deaths occur in low- and middle-income countries (LMICs), at even higher rates in the rural areas. The three-delay model assesses three different delays in accessing healthcare and can be applied to improve surgical and trauma healthcare delivery. Prior to implementing change, the capacities of the rural India healthcare system need to be identified. Objective: The object of this study was to estimate surgical and trauma care capacities of government health facilities in rural Nanakpur, Haryana, India using the Personnel, Infrastructure, Procedures, Equipment and Supplies (PIPES) and International Assessment of Capacity for Trauma (INTACT) tools. Methods: The PIPES and INTACT tools were administered at eight government health facilities serving the population of Nanakpur in June 2015. Data analysis was performed per tool subsection, and an overall score was calculated. Higher PIPES or INTACT indices correspond to greater surgical or trauma care capacity, respectively. Findings: Surgical and trauma care capacities increased with higher levels of care. The median PIPES score was significantly higher for tertiary facilities than primary and secondary facilities [13.8 (IQR 9.5, 18.2) vs. 4.7 (IQR 3.9, 6.2), p = 0.03]. The lower-level facilities were mainly lacking in personnel and procedures. Conclusions: Surgical and trauma care capacities at healthcare facilities in Haryana, India demonstrate a shortage of surgical resources at lower-level centers. Specifically, the Primary Health Centers were not operating at full capacity. These results can inform resource allocation, including increasing education, across different facility levels in rural India.

Surgical Capacity in Public and Private Health Facilities After a Five-Year Strategic Plan Implementation in Ethiopia: A Cross Sectional Study

“…Therefore, interventions including strengthening of the existing task shifting approach and monitoring of its effectiveness are among the viable ways to scale up the surgical workforce. Nevertheless, the specialized heath workforce capacity was high in the higher health care facilities (7% vs 51%) in primary and tertiary hospitals which is much higher than the finding in the study in rural India (13.8% vs 4.7%), respectively [9].…”

“…Of these, the main ones are 80% coverage of essential surgical and anaesthesia services per country (within two hours access to the facility), at least 20 surgical workforce per 100,000 population, 5,000 procedures per 100,000 population annually, and 100% protection against catastrophic expenditure from out-of-pocket payments for surgical and anaesthesia care [6,7]. However, many LMICs have challenges to achieve these targets [8,9].…”

Essential equipment and services for otolaryngology care: a proposal by the Global Otolaryngology-Head and Neck Surgery Initiative

“…Several inventories have since been developed to appraise surgical capacity, including the WHO Tool for Situational Analysis to Assess Emergency and Essential Surgical Care (SAT) [10]; the Personnel, Infrastructure, Procedures, Equipment, and Supplies (PIPES) tool [11]; and the International Assessment of Capacity for Trauma (INTACT) index [12]. These inventories have demonstrated stark surgical equipment shortages in various countries in sub-Saharan Africa [13][14][15][16][17], Asia [18][19][20][21], and Central/South America [22][23][24], highlighting the need for government involvement in surgical capacity building for both infrastructure and personnel.…”

Sustainable equipment donation in otolaryngology in low-resource settings

“…Otolaryngology-head and neck surgery (OHNS) requires a broad set of equipment to deliver essential care. Several assessments of surgical capacity in LMICs have demonstrated significant shortages of surgical equipment [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]20 ]. We conducted a pragmatic review of the literature covering the donation of equipment in OHNS.…”