Surgical Task‐Shifting in a Low‐Resource Setting: Outcomes After Major Surgery Performed by Nonphysician Clinicians in Tanzania

Beard, Jessica H.; Oresanya, Lawrence B.; Akoko, Larry; Mwanga, Ally; Mkony, Charles; Dicker, Rochelle

doi:10.1007/s00268-013-2446-2

Cited by 53 publications

(68 citation statements)

References 17 publications

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“…For example, subspecialties included in the definition of surgeon are highly variable, and some databases include trainees or non‐physician providers along with specialists. It was also recognized that using the current Commission definition of this indicator under‐represents the workforce contributing surgical care. For the purposes of comparability and benchmarking, a more uniform definition is needed.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the collection, comparability and findings of six global surgery indicators

Holmer

Bekele

Hagander

et al. 2018

British Journal of Surgery

102

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Background In 2015, six indicators were proposed to evaluate global progress towards access to safe, affordable and timely surgical and anaesthesia care. Although some have been adopted as core global health indicators, none has been evaluated systematically. The aims of this study were to assess the availability, comparability and utility of the indicators, and to present available data and updated estimates. Methods Nationally representative data were compiled for all World Health Organization (WHO) member states from 2010 to 2016 through contacts with official bodies and review of the published and grey literature, and available databases. Availability, comparability and utility were assessed for each indicator: access to timely essential surgery, specialist surgical workforce density, surgical volume, perioperative mortality, and protection against impoverishing and catastrophic expenditure. Where feasible, imputation models were developed to generate global estimates. Results Of all WHO member states, 19 had data on the proportion of the population within 2h of a surgical facility, 154 had data on workforce density, 72 reported number of procedures, and nine had perioperative mortality data, but none could report data on catastrophic or impoverishing expenditure. Comparability and utility were variable, and largely dependent on different definitions used. There were sufficient data to estimate that worldwide, in 2015, there were 2 038 947 (i.q.r. 1 884 916–2 281 776) surgeons, obstetricians and anaesthetists, and 266·1 (95 per cent c.i. 220·1 to 344·4) million operations performed. Conclusion Surgical and anaesthesia indicators are increasingly being adopted by the global health community, but data availability remains low. Comparability and utility for all indicators require further resolution.

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Section: Discussionmentioning

confidence: 99%

Evaluating the collection, comparability and findings of six global surgery indicators

Holmer

Bekele

Hagander

et al. 2018

British Journal of Surgery

102

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“…Limited surgical specialists are often cited as a barrier to accessing surgical care at district hospitals11 16, 17, 18, 19. Although the cost of the surgeon's time contributed about 60 per cent of the total personnel costs, the overall cost of personnel was still lower than that of medicines or supplies.…”

Section: Discussionmentioning

confidence: 99%

Assessing the cost of laparotomy at a rural district hospital in Rwanda using time-driven activity-based costing

et al. 2018

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BackgroundIn low‐ and middle‐income countries, the majority of patients lack access to surgical care due to limited personnel and infrastructure. The Lancet Commission on Global Surgery recommended laparotomy for district hospitals. However, little is known about the cost of laparotomy and associated clinical care in these settings.MethodsThis costing study included patients with acute abdominal conditions at three rural district hospitals in 2015 in Rwanda, and used a time‐driven activity‐based costing methodology. Capacity cost rates were calculated for personnel, location and hospital indirect costs, and multiplied by time estimates to obtain allocated costs. Costs of medications and supplies were based on purchase prices.ResultsOf 51 patients with an acute abdominal condition, 19 (37 per cent) had a laparotomy; full costing data were available for 17 of these patients, who were included in the costing analysis. The total cost of an entire care cycle for laparotomy was US$1023·40, which included intraoperative costs of US$427·15 (41·7 per cent) and preoperative and postoperative costs of US$596·25 (58·3 per cent). The cost of medicines was US$358·78 (35·1 per cent), supplies US$342·15 (33·4 per cent), personnel US$150·39 (14·7 per cent), location US$89·20 (8·7 per cent) and hospital indirect cost US$82·88 (8·1 per cent).ConclusionThe intraoperative cost of laparotomy was similar to previous estimates, but any plan to scale‐up laparotomy capacity at district hospitals should consider the sizeable preoperative and postoperative costs. Although lack of personnel and limited infrastructure are commonly cited surgical barriers at district hospitals, personnel and location costs were among the lowest cost contributors; similar location‐related expenses at tertiary hospitals might be higher than at district hospitals, providing further support for decentralization of these services.

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“…Task-shifting of surgical care to mid-level providers may be a safe and sustainable way to address the surgical workforce shortage in low resource settings [20] and has been used in a number of countries. [21] Countries have focused on accelerating the production of mid-level cadres, including anesthetists.…”

Section: Discussionmentioning

confidence: 99%

Preparing the health workforce in Ethiopia: A Cross-sectional study of competence of anesthesia graduating students

et al. 2016

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Surgical Task‐Shifting in a Low‐Resource Setting: Outcomes After Major Surgery Performed by Nonphysician Clinicians in Tanzania

Cited by 53 publications

References 17 publications

Evaluating the collection, comparability and findings of six global surgery indicators

Evaluating the collection, comparability and findings of six global surgery indicators

Assessing the cost of laparotomy at a rural district hospital in Rwanda using time-driven activity-based costing

Preparing the health workforce in Ethiopia: A Cross-sectional study of competence of anesthesia graduating students

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