‘We are all serving the same Ugandans’: A nationwide mixed-methods evaluation of private sector surgical capacity in Uganda

Abstract

IntroductionHalf of all Ugandans (49%) turn to the private or private-not-for-profit (PNFP) sectors when faced with illness, yet little is known about the capacity of these sectors to deliver surgical services. We partnered with the Ministry of Health to conduct a nationwide mixed-methods evaluation of private and PNFP surgical capacity in Uganda.MethodsA standardized validated facility assessment tool was utilized to assess facility infrastructure, service delivery, workforce, information management, and financing at a randomized nationally representative sample of 16 private and PNFP hospitals. Semi-structured interviews were conducted to qualitatively explore facilitating factors and barriers to surgical, obstetric and anaesthesia (SOA) care. Hospitals walk-throughs and retrospective reviews of operative logbooks were completed.ResultsHospitals had a median of 177 beds and two operating rooms. Ten hospitals (62.5%) were able to perform all Bellwether procedures (cesarean section, laparotomy and open fracture treatment). Thirty-day surgical volume averaged 102 cases per facility. While most hospitals had electricity, oxygen, running water, and necessary equipment, many reported pervasive shortages of blood, surgical consumables, and anesthetic drugs. Several themes emerged from the qualitative analysis: (1) geographic distance and limited transportation options delay reaching care; (2) workforce shortages impede the delivery of surgical care; (3) emergency and obstetric volume overwhelm the surgical system; (4) medical and non-medical costs delay seeking, reaching, and receiving care; and (5) there is poor coordination of care with insufficient support systems.ConclusionAs in Uganda’s public sector, barriers to surgery in private and PNFP hospitals in Uganda are cross-cutting and closely tied to resource availability. Critical policy and programmatic developments are essential to build and strengthen Ugandan surgical capacity across all sectors.

Oxygen delivery systems for adults in Sub-Saharan Africa: A scoping review

“…For example, the highest reported availability was in a study of private and public facilities in Uganda which showed that 15 of 16 facilities had access to oxygen at least half of the time. However, six of those hospitals lacked access to oxygen more than 25% of the time and one hospital never had access to oxygen [ 14 ]. The availability of pulse oximetry was significantly more limited, ranging from 0%-64% of facilities assessed [ 20 , 27 , 33 ].…”

“…This suggests that while facilities may have oxygen available, their ability to accurately identify patients who may need oxygen and titrate the amount delivered appropriately is limited. These limitations are especially true for public facilities and those providing lower tiers of care [ 13 , 14 , 28 ].…”

Assessment of diagnostics capacity in hospitals providing surgical care in two Latin American states

“…In sub-Saharan Africa, unreliable or inaccurate diagnostic testing has been shown to increase unnecessary system expenditures and lead to life-threatening misdiagnoses or delays in treatment [5] . In Uganda, a large portion of private hospitals providing surgical care do not have access to blood [37] . Furthermore, despite having less surgical volume than public hospitals, private facilities were often better equipped than public ones [37] .…”

“…In Uganda, a large portion of private hospitals providing surgical care do not have access to blood [37] . Furthermore, despite having less surgical volume than public hospitals, private facilities were often better equipped than public ones [37] . Reliable and accessible diagnostic services are paramount to SAO treatment, from cross-matching blood products, to safely titrating anesthetics, to using histopathology to determine disease type and treatment [1] .…”

It's the Destination and the Journey—A Mapping of the Challenges in Transport and Referral for Maternal and Newborn Health in Pandemics and Beyond

“…Other studies have found that many women and newborns are not stabilized prior to transport; many are discharged or referred with no follow-up plan (16). A mixed-methods study related to surgical capacity in Uganda reported on the common occurrence of women in obstructed labor receiving medication, but not being directed or escorted to a particular facility and left to coordinate their own transport (18). A report from Mexico documented cases of critically ill newborns transported without medical personnel present (19).…”