The development and roll-out of a new hydrocoele surgery facility assessment tool for the elimination of lymphatic filariasis

Abstract

A hydrocoele surgery facility assessment tool (HSFAT) was developed to assess the readiness of hydrocoele surgery services in health facilities prior to implementation of hydrocoele surgical campaigns for the elimination of lymphatic filariasis (LF). A first version of the tool was piloted in Bangladesh, Malawi and Nepal in 2019, then, following feedback from country programme managers, a second version of the tool was rolled out across countries implementing hydrocoele surgery in the Accelerating the Control of Neglected Tropical Diseases (Ascend) West and Central Africa Programme, including Benin, Burkina Faso, Ghana, Guinea, Niger and Nigeria. The HSFAT assessed facilities across 10 domains: background information, essential amenities, emergency patient transfer, laboratory capacity, surgical procedures and trained staff, infection prevention, non-disposable basic equipment, disposable basic equipment, essential medicines and current hydrocoele practices. The HSFAT results highlight key areas for improvement in different countries and can be used to develop a quality improvement plan, which may include actions with agreed deadlines to improve the readiness and quality of hydrocoele surgery services provided by the health facility, prior to implementation of surgical campaigns and assist country programmes to achieve the dossier requirements set out by the World Health Organization for the elimination of LF.

Elimination of lymphatic filariasis as a public health problem in Malawi

“…Hydrocoele Surgery Facility Assessment Tool (HSFAT): To determine the readiness and quality of hydrocelectomy services, a new tool was developed and trialled in Malawi in February 2019 [ 43 ]. It used indicators from the WHO Service Availability and Readiness Assessment (SARA), and the WHO publication ‘Surgical approaches to the urogenital manifestations of lymphatic filariasis’ [ 14 ].…”

“…It was also deemed important to assess the hospitals current practice including the number of facilities available, availability of protocols, method of surgery, pre- and post-operative procedures, and methods of follow-up. The methods and results are described elsewhere [ 43 ]. A summary of key indicators from 24 hospitals surveyed across endemic districts in 2019 is shown in Table 5 .…”

“…Since 2015 more than 1500 surgeries in high endemic districts have been performed, and research conducted to assess the impact of surgery on patients found an overall low rate of post-operative complications and significant improvements in patient's quality of life [40], which also has a positive impact on their families, specifically caregivers [41]. Further an economic assessment found that the lifetime benefits of surgery to the individual, his family, and his community greatly outweigh the low cost of surgery (estimated at US$68 during campaigns) in Malawi [42] Hydrocoele Surgery Facility Assessment Tool (HSFAT): To determine the readiness and quality of hydrocelectomy services, a new tool was developed and trialled in Malawi in February 2019 [43]. It used indicators from the WHO Service Availability and Readiness Assessment (SARA), and the WHO publication 'Surgical approaches to the urogenital manifestations of lymphatic filariasis' [14].…”

The national distribution of lymphatic filariasis cases in Malawi using patient mapping and geostatistical modelling

“…Assessing the capacity of hospitals, the infrastructure, human and financial resources required for these surgeries is important to determine whether they can be provided routinely through the health system. A hospital facility assessment to determine the readiness and quality of hydrocelectomy services has been conduced in Malawi in 2019 [ 46 ]. To reduce the backlog of cases, hydrocoele campaigns were conduced periodically from 2008 completing more than 1500 surgeries in high burden districts, Karonga, Chikwawa and Nsanje [ 11 ].…”

Neglected tropical disease elimination is a relay race – let's not drop the baton

“…The sustainability of NTD services and some of the key considerations to frame the discussion are captured by Rowan et al 22 by laying out the approach taken by Ascend to address key components of strong health systems, by Martindale et al, 23 who describe new tools to assess the quality and preparedness of health facilities to manage incident cases of hydrocele, and by Jones and Downs, 24 who argue that the investments made in fighting NTDs have unlocked far greater resources and opportunities to engage communities on health issues beyond just NTDs.…”