Surgical care at rural district hospitals in low- and middle-income countries: an essential component of universal health coverage

Chu, Kathryn; Hendriks, H. Jurgens; Nash, Jennifer; Coetzee, Francois; Esteves, Martene; Reid, Steve; Couper, Ian

doi:10.22605/rrh5920

Cited by 11 publications

(17 citation statements)

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“…Although family medicine has defined the surgical skills for training of FPs there is a need to update the package of emergency and essential surgical procedures in policy. 13,14 Surgery comes with some form of anaesthesia. To be able to function in a DH setting, one needs to be comfortable with spinal and general anaesthesia, as well as some blocks (e.g.…”

Section: Reflections On Family Physicians and Surgery At District Hospitalsmentioning

confidence: 99%

The contribution of family physicians to surgical capacity at district hospitals in South Africa

Hendriks

Adeniji

Jenkins

et al. 2021

African Journal of Primary Health Care & Family Medicine

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The World Health Organization states that essential, cost-effective surgical care should be delivered at district hospitals. In South Africa significant skills gap exist at district hospitals, particularly in the area of surgery and anaesthesia. These small to moderate sized hospitals are too small to support a range of full time specialists even if they could be recruited and were cost-effective. Family physicians (FPs) are trained in the clinical skills required for district hospitals and primary health care. Clinical associates have also been introduced to perform procedures at district hospitals. This report illustrates the contribution of a FP to surgical care at Zithulele Hospital in the Eastern Cape. Family physicians not only bring the necessary clinical skills set but also increase the confidence and capacity of the whole team. Outreach and support by surgeons, as well as continuing professional development, are important. Surgical and anaesthetic skills must be developed together. Family physicians also bring leadership and clinical governance skills that ensure the inputs to support surgery, such as equipment and information systems are available. The contribution of FPs to surgery and district hospitals is overlooked in both policy and practice. Human resources for health policy should recognise their contribution and increase the numbers available and FP posts at district hospitals. There is also a need to update the package of emergency and essential surgical procedures in policy.

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Section: Reflections On Family Physicians and Surgery At District Hospitalsmentioning

confidence: 99%

The contribution of family physicians to surgical capacity at district hospitals in South Africa

Hendriks

Adeniji

Jenkins

et al. 2021

African Journal of Primary Health Care & Family Medicine

Self Cite

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“…Other surgical services require FPs and RNs with enhanced skills in general surgery and anesthesia, such as advanced practice nurses or nurse practitioners, as well as other support staff and service capacity including laboratory medicine, diagnostic imaging, and pharmacy with associated equipment and facilities. A common model in many LMICs is a "district hospital," where the generalist FPs with a range of enhanced skills are based, and staff includes RNs and other trained health personnel that support a network of village clinics staffed by CHWs and RNs who may be local or visiting from the district hospital (Fields, Sibanda, and Couper 2020;Chu et al 2020). The district hospital and community clinics are in effect the "expanded PHC team" that provides continuing comprehensive care for almost all common health problems supported by specialists based in regional hospitals and larger population centers.…”

Section: Local and Expanded Phc Teammentioning

confidence: 99%

Reimaging Primary Health Care Workforce in Rural and Underserved Settings

Strasser¹,

Strasser²

2020

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This series is produced by the Health, Nutrition, and Population Global Practice of the World Bank. The papers in this series aim to provide a vehicle for publishing preliminary results on HNP topics to encourage discussion and debate. The findings, interpretations, and conclusions expressed in this paper are entirely those of the author(s) and should not be attributed in any manner to the World Bank, to its affiliated organizations, or to members of its Board of Executive Directors or the countries they represent. Citation and the use of material presented in this series should take into account this provisional character.The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of the World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries.

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“…It is suspected that most surgical disease occurs in populations without access to effective treatment 13,14 . As a consequence, there has been some discussion in the literature about how best to provide surgical care in this context 15 .…”

Section: Introductionmentioning

confidence: 99%

Inguinal hernia repair: a global perspective

O’Brien

Sinha

Turner

2021

ANZ Journal of Surgery

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Background Inguinal hernia repair is one of the most common operations performed worldwide with most of the burden of these occurring in low‐ or middle‐income countries (LMICs). There has been much research investigating the most effective method of hernia repair in resource‐rich countries, however very little has been done to determine the most cost‐beneficial method of hernia repair in LMICs. Methods A systematic review of the English literature through PubMed and Scopus was conducted according to the PRISMA statement. Results Twenty‐eight studies met the inclusion criteria of which 17 were randomised controlled trials and 11 were systematic reviews. Three areas of investigation were established from the literature search, namely operative method and type of mesh used (where applicable). Open‐mesh procedures were shown to be less costly and have shorter operative times than laparoscopic methods. People who underwent laparoscopic hernia repair regularly returned to normal activities earlier than those who had open‐mesh procedures. However, there was no other difference in complication rates between these two methods. Recent investigations have revealed that sterilised synthetic mosquito net was similar to hernia‐specific meshes whilst significantly reducing cost. Conclusion We postulate that the most cost‐beneficial method of hernia repair for implementation in LMICs is using open‐mesh procedures with sterilised mosquito net under local anaesthetic. Further cost–benefit research is required in this area.

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Surgical care at rural district hospitals in low- and middle-income countries: an essential component of universal health coverage

Cited by 11 publications

References 0 publications

The contribution of family physicians to surgical capacity at district hospitals in South Africa

The contribution of family physicians to surgical capacity at district hospitals in South Africa

Reimaging Primary Health Care Workforce in Rural and Underserved Settings

Inguinal hernia repair: a global perspective

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