Assessment of Surgical Care Provided in National Health Services Hospitals in Mozambique: The Importance of Subnational Metrics in Global Surgery

Abstract

Introduction Surgery plays a critical role in sustainable healthcare systems. Validated metrics exist to guide implementation of surgical services, but low-income countries (LIC) struggle to report recommended metrics and this poses a critical barrier to addressing unmet need. We present a comprehensive national sample of surgical encounters from a LIC by assessing the National Health Services of Mozambique. Material and methods A prospective cohort of all surgical encounters from Mozambique's National Health Service was gathered for all provinces between July and December 2015. Primary outcomes were timely access, provider densities for surgery, anesthesiology, and obstetrics (SAO) per 100,000 population, annualized surgical procedure volume per 100,000, and postoperative mortality (POMR). Secondary outcomes include operating room density and efficiency.Results Fifty-four hospitals had surgical capacity in 11 provinces with 47,189 surgeries. 44.9% of Mozambique's population lives in Districts without access to surgical services. National SAO density was 1.2/100,000, ranging from 0.4/100,000 in Manica Province to 9.8/100,000 in Maputo City. Annualized national surgical case volume was 367 procedures/100,000 population, ranging from 180/100,000 in Zambezia Province to 1,897/100,000 in Maputo City. National POMR was 0.74% and ranged from 0.23% in Maputo Province to 1.78% in Niassa Province. Discussion Surgical delivery in Mozambique falls short of international targets. Subnational deficiencies and variations between provinces pose targets for quality improvement in advancing national surgical plans. This serves as a template for LICs to follow in gathering surgical metrics for the WHO and the World Bank and offers short-and long-term targets for surgery as a component of health systems strengthening.

Fostering Sustainable Biomedical Research Training in Mozambique: A Spin-Off of the Medical Education Partnership Initiative

“…On the other hand, the record also reflects the chronic scarcity of national/African mentors [ 12 15 ]. The experiences and scientific knowledge generated at various scientific meetings also contributed to the design of policies and guidelines, helped to prioritize resource allocation, and attracted more investments to the health sector, thus contributing to the sustainable development of the country towards achievement of equity in global health, as widely documented in the literature [ 3 12 15 21 24 25 26 27 28 29 30 31 32 33 34 35 ]. Because peer-reviewed journal publication is a prolonged process, especially for researchers with less-developed writing skills [ 24 ], the number of publications listed does not fully reflect the impact of the present Fogarty training program, as some program participants are still pursuing studies, conducting research and writing manuscripts.…”

“…This Fogarty training grant fostered north-south and south-south collaboration among MEPI schools and their US counterparts through the AFREhealth forum and MEPI D43 networking meetings, CUGH conferences, and the European and Developing Countries Clinical Trials Partnership (EDCTP) forum meetings and allowed joint research and publications on the most pressing health issues related to the African continent, and Mozambique in particular [ 26 21 27 28 29 30 31 32 34 35 ].…”

Design and Implementation of Postgraduate Programs in Health in a Resource-Limited Setting in Mozambique (The Lúrio University)

“…10,11 The distribution of health professionals across the country is not uniform, with more deficits in the north and central provinces, such as Nampula, Niassa, Cabo Delgado, and Zambeze. 12,13 To further exacerbate the scarcity of the health workforce in the country, the average academic qualifications are low. In 2016, out of the total health professionals employed by the Ministry of Health, 10% were of early primary school level, 51% of basic level, 32% of high school level, and 7% of University level.…”

“…78%), and leprosy (0.006%). Nampula is one of the provinces with the highest number of active cases of tuberculosis (13,938 cases in 2019) inhabitants with the majority of cases due to co-infection with HIV/AIDS. 16,[18][19][20][21]24,25 Furthermore, the northern and central provinces are less served by health professionals.…”

A Nationwide Enumeration of the Surgical Workforce, its Production and Disparities in Operative Productivity in Liberia

“…The density of specialist surgical providers has been described as a key metric to benchmark and monitor development worldwide [ 3 ]. To complement global metrics, subnational analysis has been highlighted as an important tool to reveal in-country challenges [ 6 , 7 ]. Operative productivity is a measure that has been used to describe surgical systems both at the provider level [ 8 ] and at the facility level [ 9 ].…”