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, Samuel; Matovu, Alphonsus; Miranda, Helder de; Ozgediz, Doruk; Quiñones, Ana; Rockers, Peter C.; Schreeb, Johan von; Vaz, Fernando; Debas, Haile T.; Macfarlane, Sarah B.

doi:10.1371/journal.pmed.1000242

Cited by 112 publications

(93 citation statements)

References 29 publications

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“…18,20,54,74 Programmes are most effective when simple sustainable changes are introduced and the support is ongoing, allowing for safe expansion of the services offered. 69,74 Cost-effective strategies include the introduction of pulse oximetry, 18,72 investment in staff training, especially airway skills and CPR, and the introduction of safety checklists 51,72 and protocol-driven care. 74 Safe care is further hampered by the nonavailability of basic infrastructure, equipment, medication, fluids, blood and human resources.…”

Section: Discussionmentioning

confidence: 99%

“…68 • Inexperienced or untrained practitioners. 5,18,20,53,55,58,60,65,69 Cardiac arrest and mortality, as a result of failing to recognise hypovolaemia, is common in developing and developed countries. 13 …”

Section: American Society Of Anesthesiologists Statusmentioning

confidence: 99%

“…The majority of anaesthetic-related causes of death are highly preventable through basic interventions and investment in surgical and anaesthetic services in the developing world. 69 WHO initiatives have been introduced to address these issues, 89 but will fail if health system issues, governance and funding are not urgently addressed. 18,20,54,66 Recommendations Access to and the safety of surgery is key in addressing the unmet global burden of surgically treatable disease.…”

Section: Access and Patient Factorsmentioning

confidence: 99%

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A review of paediatric anaesthetic-related mortality, serious adverse events and critical incidents

Cronjé

2015

Southern African Journal of Anaesthesia and Analgesia

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Anaesthetists increasingly face questions from parents on the long-term outcomes of anaesthesia, and yet more immediate anaesthetic risks are not understood, nor explained to families. This review focused on paediatric anaesthetic-related mortality, cardiac arrest and anaesthetic-related serious adverse events and critical incidents during general anaesthesia, and within 24 hours of anaesthesia ending. Anaesthetic-related mortality is rare in the developed world, and is approximately 1 per 10 000 anaesthetics, but increases in high-risk children. Serious anaesthetic-related adverse events occur in 1.4 per 1 000 anaesthetics in the developed world. Data are lacking from the developing world but anaesthetic mortality is 2-3 times higher in middle-income countries and may be up to 100-fold greater in low-income countries. A critical incident occurs in 3-8% of anaesthetics and this figure is double that in low-income countries. Anaesthetic-related events are predominantly preventable. Brief recommendations on preventative strategies are made and research goals outlined.

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Section: Discussionmentioning

confidence: 99%

Section: American Society Of Anesthesiologists Statusmentioning

confidence: 99%

Section: Access and Patient Factorsmentioning

confidence: 99%

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A review of paediatric anaesthetic-related mortality, serious adverse events and critical incidents

Cronjé

2015

Southern African Journal of Anaesthesia and Analgesia

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“…Personnel cost was the third lowest cost contributor overall and the third lowest for the intraoperative costs. Although this is markedly lower than other estimates of personnel‐related costs relative to overall inpatient surgical costs19, in this context the cost of the surgeon may not be the limiting factor as much as the deficit of available surgeons. Rwanda has only 0·15 general surgeons per 100 000 population10, compared with six per 100 000 population in developed nations20.…”

Section: Discussionmentioning

confidence: 68%

“…Limited surgical specialists are often cited as a barrier to accessing surgical care at district hospitals11 16, 17, 18, 19. Although the cost of the surgeon's time contributed about 60 per cent of the total personnel costs, the overall cost of personnel was still lower than that of medicines or supplies.…”

Section: Discussionmentioning

confidence: 99%

Assessing the cost of laparotomy at a rural district hospital in Rwanda using time-driven activity-based costing

et al. 2018

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BackgroundIn low‐ and middle‐income countries, the majority of patients lack access to surgical care due to limited personnel and infrastructure. The Lancet Commission on Global Surgery recommended laparotomy for district hospitals. However, little is known about the cost of laparotomy and associated clinical care in these settings.MethodsThis costing study included patients with acute abdominal conditions at three rural district hospitals in 2015 in Rwanda, and used a time‐driven activity‐based costing methodology. Capacity cost rates were calculated for personnel, location and hospital indirect costs, and multiplied by time estimates to obtain allocated costs. Costs of medications and supplies were based on purchase prices.ResultsOf 51 patients with an acute abdominal condition, 19 (37 per cent) had a laparotomy; full costing data were available for 17 of these patients, who were included in the costing analysis. The total cost of an entire care cycle for laparotomy was US$1023·40, which included intraoperative costs of US$427·15 (41·7 per cent) and preoperative and postoperative costs of US$596·25 (58·3 per cent). The cost of medicines was US$358·78 (35·1 per cent), supplies US$342·15 (33·4 per cent), personnel US$150·39 (14·7 per cent), location US$89·20 (8·7 per cent) and hospital indirect cost US$82·88 (8·1 per cent).ConclusionThe intraoperative cost of laparotomy was similar to previous estimates, but any plan to scale‐up laparotomy capacity at district hospitals should consider the sizeable preoperative and postoperative costs. Although lack of personnel and limited infrastructure are commonly cited surgical barriers at district hospitals, personnel and location costs were among the lowest cost contributors; similar location‐related expenses at tertiary hospitals might be higher than at district hospitals, providing further support for decentralization of these services.

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Assessing the Surgical and Obstetrics-Gynecology Workload of Medical Officers

Mehtsun¹,

Weatherspoon²,

McElrath³

et al. 2012

Arch Surg

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Human Resource and Funding Constraints for Essential Surgery in District Hospitals in Africa: A Retrospective Cross-Sectional Survey

Abstract: In the second of two papers investigating surgical provision in eight district hospitals in Saharan African countries, Margaret Kruk and colleagues describe the range of providers of surgical care and anesthesia and estimate the related costs.

Cited by 112 publications

References 29 publications

A review of paediatric anaesthetic-related mortality, serious adverse events and critical incidents

A review of paediatric anaesthetic-related mortality, serious adverse events and critical incidents

Assessing the cost of laparotomy at a rural district hospital in Rwanda using time-driven activity-based costing

Assessing the Surgical and Obstetrics-Gynecology Workload of Medical Officers

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