Human resource and funding constraints for essential surgery in district hospitals in Africa

a retrospective cross-sectional survey.

Margaret E. Kruk, Andreas Wladis, Naboth Mbembati, S. Khady Ndao-Brumblay, Renee Y. Hsia, Moses Galukande, Sam Luboga, Alphonsus Matovu, Helder de Miranda, Doruk Ozgediz, Ana Quinones, Peter C. Rockers, Johan von Schreeb, Fernando Vaz, Haile T. Debas, Sarah B. Macfarlane

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

BACKGROUND: There is a growing recognition that the provision of surgical services in low-income countries is inadequate to the need. While constrained health budgets and health worker shortages have been blamed for the low rates of surgery, there has been little empirical data on the providers of surgery and cost of surgical services in Africa. This study described the range of providers of surgical care and anesthesia and estimated the resources dedicated to surgery at district hospitals in three African countries. METHODS AND FINDINGS: We conducted a retrospective cross-sectional survey of data from eight district hospitals in Mozambique, Tanzania, and Uganda. There were no specialist surgeons or anesthetists in any of the hospitals. Most of the health workers were nurses (77.5%), followed by mid-level providers (MLPs) not trained to provide surgical care (7.8%), and MLPs trained to perform surgical procedures (3.8%). There were one to six medical doctors per hospital (4.2% of clinical staff). Most major surgical procedures were performed by doctors (54.6%), however over one-third (35.9%) were done by MLPs. Anesthesia was mainly provided by nurses (39.4%). Most of the hospital expenditure was related to staffing. Of the total operating costs, only 7% to 14% was allocated to surgical care, the majority of which was for obstetric surgery. These costs represent a per capita expenditure on surgery ranging from US$0.05 to US$0.14 between the eight hospitals. CONCLUSION: African countries have adopted different policies to ensure the provision of surgical care in their respective district hospitals. Overall, the surgical output per capita was very low, reflecting low staffing ratios and limited expenditures for surgery. We found that most surgical and anesthesia services in the three countries in the study were provided by generalist doctors, MLPs, and nurses. Although more information is needed to estimate unmet need for surgery, increasing the funds allocated to surgery, and, in the absence of trained doctors and surgeons, formalizing the training of MLPs appears to be a pragmatic and cost-effective way to make basic surgical services available in underserved areas. Please see later in the article for the Editors' Summary.

Original languageEnglish (US)
JournalNature Methods
Volume7
Issue number3
DOIs
StatePublished - 2010
Externally publishedYes

Fingerprint

District Hospitals
Surgery
Cross-Sectional Studies
Personnel
Health Expenditures
Costs and Cost Analysis
Anesthesia
Nurses
Health
Obstetric Surgical Procedures
Mozambique
Obstetrics
Uganda
Tanzania
Costs
Budgets
Financial Management
Operating costs

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Kruk, M. E., Wladis, A., Mbembati, N., Ndao-Brumblay, S. K., Hsia, R. Y., Galukande, M., ... Macfarlane, S. B. (2010). Human resource and funding constraints for essential surgery in district hospitals in Africa: a retrospective cross-sectional survey. Nature Methods, 7(3). https://doi.org/10.1371/journal.pmed.1000242

Human resource and funding constraints for essential surgery in district hospitals in Africa : a retrospective cross-sectional survey. / Kruk, Margaret E.; Wladis, Andreas; Mbembati, Naboth; Ndao-Brumblay, S. Khady; Hsia, Renee Y.; Galukande, Moses; Luboga, Sam; Matovu, Alphonsus; de Miranda, Helder; Ozgediz, Doruk; Quinones, Ana; Rockers, Peter C.; von Schreeb, Johan; Vaz, Fernando; Debas, Haile T.; Macfarlane, Sarah B.

In: Nature Methods, Vol. 7, No. 3, 2010.

Research output: Contribution to journalArticle

Kruk, ME, Wladis, A, Mbembati, N, Ndao-Brumblay, SK, Hsia, RY, Galukande, M, Luboga, S, Matovu, A, de Miranda, H, Ozgediz, D, Quinones, A, Rockers, PC, von Schreeb, J, Vaz, F, Debas, HT & Macfarlane, SB 2010, 'Human resource and funding constraints for essential surgery in district hospitals in Africa: a retrospective cross-sectional survey.', Nature Methods, vol. 7, no. 3. https://doi.org/10.1371/journal.pmed.1000242
Kruk, Margaret E. ; Wladis, Andreas ; Mbembati, Naboth ; Ndao-Brumblay, S. Khady ; Hsia, Renee Y. ; Galukande, Moses ; Luboga, Sam ; Matovu, Alphonsus ; de Miranda, Helder ; Ozgediz, Doruk ; Quinones, Ana ; Rockers, Peter C. ; von Schreeb, Johan ; Vaz, Fernando ; Debas, Haile T. ; Macfarlane, Sarah B. / Human resource and funding constraints for essential surgery in district hospitals in Africa : a retrospective cross-sectional survey. In: Nature Methods. 2010 ; Vol. 7, No. 3.
@article{212c43705aa54131a39cdd88e28f8901,
title = "Human resource and funding constraints for essential surgery in district hospitals in Africa: a retrospective cross-sectional survey.",
abstract = "BACKGROUND: There is a growing recognition that the provision of surgical services in low-income countries is inadequate to the need. While constrained health budgets and health worker shortages have been blamed for the low rates of surgery, there has been little empirical data on the providers of surgery and cost of surgical services in Africa. This study described the range of providers of surgical care and anesthesia and estimated the resources dedicated to surgery at district hospitals in three African countries. METHODS AND FINDINGS: We conducted a retrospective cross-sectional survey of data from eight district hospitals in Mozambique, Tanzania, and Uganda. There were no specialist surgeons or anesthetists in any of the hospitals. Most of the health workers were nurses (77.5{\%}), followed by mid-level providers (MLPs) not trained to provide surgical care (7.8{\%}), and MLPs trained to perform surgical procedures (3.8{\%}). There were one to six medical doctors per hospital (4.2{\%} of clinical staff). Most major surgical procedures were performed by doctors (54.6{\%}), however over one-third (35.9{\%}) were done by MLPs. Anesthesia was mainly provided by nurses (39.4{\%}). Most of the hospital expenditure was related to staffing. Of the total operating costs, only 7{\%} to 14{\%} was allocated to surgical care, the majority of which was for obstetric surgery. These costs represent a per capita expenditure on surgery ranging from US$0.05 to US$0.14 between the eight hospitals. CONCLUSION: African countries have adopted different policies to ensure the provision of surgical care in their respective district hospitals. Overall, the surgical output per capita was very low, reflecting low staffing ratios and limited expenditures for surgery. We found that most surgical and anesthesia services in the three countries in the study were provided by generalist doctors, MLPs, and nurses. Although more information is needed to estimate unmet need for surgery, increasing the funds allocated to surgery, and, in the absence of trained doctors and surgeons, formalizing the training of MLPs appears to be a pragmatic and cost-effective way to make basic surgical services available in underserved areas. Please see later in the article for the Editors' Summary.",
author = "Kruk, {Margaret E.} and Andreas Wladis and Naboth Mbembati and Ndao-Brumblay, {S. Khady} and Hsia, {Renee Y.} and Moses Galukande and Sam Luboga and Alphonsus Matovu and {de Miranda}, Helder and Doruk Ozgediz and Ana Quinones and Rockers, {Peter C.} and {von Schreeb}, Johan and Fernando Vaz and Debas, {Haile T.} and Macfarlane, {Sarah B.}",
year = "2010",
doi = "10.1371/journal.pmed.1000242",
language = "English (US)",
volume = "7",
journal = "PLoS Medicine",
issn = "1549-1277",
publisher = "Nature Publishing Group",
number = "3",

}

TY - JOUR

T1 - Human resource and funding constraints for essential surgery in district hospitals in Africa

T2 - a retrospective cross-sectional survey.

AU - Kruk, Margaret E.

AU - Wladis, Andreas

AU - Mbembati, Naboth

AU - Ndao-Brumblay, S. Khady

AU - Hsia, Renee Y.

AU - Galukande, Moses

AU - Luboga, Sam

AU - Matovu, Alphonsus

AU - de Miranda, Helder

AU - Ozgediz, Doruk

AU - Quinones, Ana

AU - Rockers, Peter C.

AU - von Schreeb, Johan

AU - Vaz, Fernando

AU - Debas, Haile T.

AU - Macfarlane, Sarah B.

PY - 2010

Y1 - 2010

N2 - BACKGROUND: There is a growing recognition that the provision of surgical services in low-income countries is inadequate to the need. While constrained health budgets and health worker shortages have been blamed for the low rates of surgery, there has been little empirical data on the providers of surgery and cost of surgical services in Africa. This study described the range of providers of surgical care and anesthesia and estimated the resources dedicated to surgery at district hospitals in three African countries. METHODS AND FINDINGS: We conducted a retrospective cross-sectional survey of data from eight district hospitals in Mozambique, Tanzania, and Uganda. There were no specialist surgeons or anesthetists in any of the hospitals. Most of the health workers were nurses (77.5%), followed by mid-level providers (MLPs) not trained to provide surgical care (7.8%), and MLPs trained to perform surgical procedures (3.8%). There were one to six medical doctors per hospital (4.2% of clinical staff). Most major surgical procedures were performed by doctors (54.6%), however over one-third (35.9%) were done by MLPs. Anesthesia was mainly provided by nurses (39.4%). Most of the hospital expenditure was related to staffing. Of the total operating costs, only 7% to 14% was allocated to surgical care, the majority of which was for obstetric surgery. These costs represent a per capita expenditure on surgery ranging from US$0.05 to US$0.14 between the eight hospitals. CONCLUSION: African countries have adopted different policies to ensure the provision of surgical care in their respective district hospitals. Overall, the surgical output per capita was very low, reflecting low staffing ratios and limited expenditures for surgery. We found that most surgical and anesthesia services in the three countries in the study were provided by generalist doctors, MLPs, and nurses. Although more information is needed to estimate unmet need for surgery, increasing the funds allocated to surgery, and, in the absence of trained doctors and surgeons, formalizing the training of MLPs appears to be a pragmatic and cost-effective way to make basic surgical services available in underserved areas. Please see later in the article for the Editors' Summary.

AB - BACKGROUND: There is a growing recognition that the provision of surgical services in low-income countries is inadequate to the need. While constrained health budgets and health worker shortages have been blamed for the low rates of surgery, there has been little empirical data on the providers of surgery and cost of surgical services in Africa. This study described the range of providers of surgical care and anesthesia and estimated the resources dedicated to surgery at district hospitals in three African countries. METHODS AND FINDINGS: We conducted a retrospective cross-sectional survey of data from eight district hospitals in Mozambique, Tanzania, and Uganda. There were no specialist surgeons or anesthetists in any of the hospitals. Most of the health workers were nurses (77.5%), followed by mid-level providers (MLPs) not trained to provide surgical care (7.8%), and MLPs trained to perform surgical procedures (3.8%). There were one to six medical doctors per hospital (4.2% of clinical staff). Most major surgical procedures were performed by doctors (54.6%), however over one-third (35.9%) were done by MLPs. Anesthesia was mainly provided by nurses (39.4%). Most of the hospital expenditure was related to staffing. Of the total operating costs, only 7% to 14% was allocated to surgical care, the majority of which was for obstetric surgery. These costs represent a per capita expenditure on surgery ranging from US$0.05 to US$0.14 between the eight hospitals. CONCLUSION: African countries have adopted different policies to ensure the provision of surgical care in their respective district hospitals. Overall, the surgical output per capita was very low, reflecting low staffing ratios and limited expenditures for surgery. We found that most surgical and anesthesia services in the three countries in the study were provided by generalist doctors, MLPs, and nurses. Although more information is needed to estimate unmet need for surgery, increasing the funds allocated to surgery, and, in the absence of trained doctors and surgeons, formalizing the training of MLPs appears to be a pragmatic and cost-effective way to make basic surgical services available in underserved areas. Please see later in the article for the Editors' Summary.

UR - http://www.scopus.com/inward/record.url?scp=77952747035&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77952747035&partnerID=8YFLogxK

U2 - 10.1371/journal.pmed.1000242

DO - 10.1371/journal.pmed.1000242

M3 - Article

VL - 7

JO - PLoS Medicine

JF - PLoS Medicine

SN - 1549-1277

IS - 3

ER -