Emergency and surgery services of primary hospitals in the United Republic of Tanzania

Abstract

ObjectiveThe primary objective was to evaluate the capacity of first-referral health facilities in Tanzania to perform basic surgical procedures. The intent was to assist in planning strategies for universal access to life-saving and disability-preventing surgical services.DesignCross-sectional survey.SettingFirst-referral health facilities in the United Republic of Tanzania.Participants48 health facilities.MeasuresThe WHO Tool for Situational Analysis to Assess Emergency and Essential Surgical Care was employed to capture a health facility's capacity to perform basic surgical (including obstetrics and trauma) and anaesthesia interventions by investigating four categories of data: infrastructure, human resources, interventions available and equipment. The tool queried the availability of eight types of care providers, 35 surgical interventions and 67 items of equipment.ResultsThe 48 facilities surveyed served 18.6 million residents (46% of the population). Supplies for basic airway management were inconsistently available. Only 42% had consistent access to oxygen, and only six functioning pulse oximeters were located in all facilities surveyed. 37.5% of facilities reported both consistent running water and electricity. While very basic interventions (suturing, wound debridement, incision and drainage) were provided in nearly all facilities, more advanced life-saving procedures including chest tube thoracostomy (30/48), open fracture management (29/48) and caesarean section delivery (32/48) were not consistently available.ConclusionsBased on the results in this WHO country survey, significant gaps exist in the capacity for emergency and essential surgical services in Tanzania including deficits in human resources, essential equipment and infrastructure. The information in this survey will provide a foundation for evidence-based decisions in country-level policy regarding the allocation of resources and provision of emergency and essential surgical services.

Situational Analysis of Essential Surgical Care Management in Iran Using the WHO Tool

“…Our findings identified the gaps in the infrastructure, human resources, surgical interventions, and essential equipment and indicated that suitable facilities and equipment, human resources, and infrastructure are available in the district hospitals in Iran at a standard higher than that in many of the LMICs which have evaluated and published the status of their own essential surgical care (11)(12)(13)(14)(15)(16)(17). Our results also showed a significant improvement in status by comparison with the situation 5 years ago in Iran.…”

“…This tool is used to assess surgical needs in many developing countries and has been translated into Farsi and validated and employed in Iran by Mouseli (2009) (10)(11)(12). However, the researcher improved and completed the translation of the tool before it was utilized.…”

Time intervals in the treatment of fractured femurs as indicators of the quality of trauma systems

“…The hospitals that we investigated were all tertiary-care institutions and in most low-and middle-income countries there are many peripheral hospitals for each such tertiary-care institution. The peripheral rural hospitals are particularly likely to have low resources 27 and patients attending such hospitals with fractured femurs are more likely to be treated with traction than with intramedullary nailing. Our data probably therefore underestimate the mean length of time it would take a patient with a fractured femur to flow through a trauma system in a low-or middleincome country.…”

“…5,26 The admission to surgery interval is affected by in-hospital variables such as the availability of human resources and essential equipment and the hospital infrastructure. 27 The final surgery to discharge interval may be affected by medication availability, nursing care, rehabilitation and the postoperative availability of social services. 28,29 This study proposes that the intervals from injury to admission, admission to surgery and/or surgery to discharge in the care of traumatic, isolated fractures of the femoral shaft can be good indicators of the general quality of musculoskeletal trauma services and can be validated as indicators against national economic and health system parameters, which are the best available data for such validation.…”

Assessing unmet anaesthesia need in Sierra Leone: a secondary analysis of a cluster-randomized, cross-sectional, countrywide survey

“…1 It is recognized that surgery and anaesthesia services in low-and middle-income countries (LMICs) are un-der-equipped and under-staffed. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Most of this data comes from assessments of personnel, supplies and workload at institutions throughout the low resource world. It clearly demonstrates that surgical and anaesthesia services are unable to meet the current need, but gives no sense as to the true extent and nature of unmet need.…”