Implementing surgical services in a rural, resource-limited setting: a study protocol

Abstract

IntroductionThere are well-established protocols and procedures for the majority of common surgical diseases, yet surgical services remain largely inaccessible for much of the world's rural poor. Data on the process and outcome of surgical care expansion, however, are very limited, and the roll-out process of rural surgical implementation in particular has never been studied. Here, we propose the first implementation research study to assess the surgical scale-up process in the rural district of Achham, Nepal.Methods and analysisBased primarily on the protocols of the WHO's Integrated Management for Emergency and Essential Surgical Care (IMEESC), this study's threefold implementation strategy will include: (1) the core IMEESC surgical care program, (2) community-based follow-up via health workers, and (3) hospital-based quality improvement programs. The implementation program will employ additional emergency and surgical care protocols developed collaboratively by physicians, nurses and the authors. This strategy will be referred to as IMEESC-Plus. This study will employ both qualitative and quantitative research methodologies to collect clinical data and information on the reception and utilisation of services. The first 18 months of the implementation process will be studied and divided into an initial phase (first 6 months) and a consolidation phase (subsequent 12 months).DiscussionThis study aims to describe the logistics of the implementation process of IMEESC-Plus, and assess the quality of the resulting IMEESC-Plus services during the course of the implementation process. Using data generated from this study, larger, multi-site implementation studies can be planned that assess the scale-up of surgical services worldwide in resource-limited areas.

Humanitarian Outreach in Cardiothoracic Surgery: From Setup to Sustainability

“…The consequence is an alarming incidence of potentially surgically correctable cardiothoracic disease. In countries that truly lack any of the essential components for the performance of cardiothoracic surgery (catheterization laboratories, bypass machines, availability of blood products, monitoring equipment, trained personnel, and so forth), the only access to life-saving cardiothoracic surgery is through referral abroad or the episodic presence of expatriate teams [18][19][20][21]. Referral abroad, because of the evident costs and logistical challenges, is available to only a vanishingly small number of patients.…”

Costs, Effectiveness, and Cost-Effectiveness of Selected Surgical Procedures and Platforms

“…Bayalpata Hospital in Nepal offers a unique case study for understanding the financial issues of scaling up (Maru and others 2011). This hospital serves as the referral hospital for the Achham district's primary health care centers, as well as for populations from two adjacent districts.…”

“…The WHO developed an Integrated Management of Emergency and Essential Surgical Care (IMEESC) program in LMICs (WHO 2006). Bayalpata Hospital in Nepal upgraded its services under the IMEESC-Plus program (Maru and others 2011). This upgrade included the list of essential services proposed under IMEESC and two other components: community follow-up of surgical cases and quality improvement of hospital care.…”

Through the Eyes of a General Surgeon; Why Surgical Specialists in Sub Saharan Africa Need to Train in General Surgery First

“…This delays care; no wonder most of the operations are emergencies to address complications from elective surgical diseases left unattended for too long. Farther east, Maru et al [7] have criticised the WHO integrated essential and emergency surgical care as being insufficient to address the rural surgical needs of a developing country in terms of explicit mechanisms of community based follow-up and quality improvement [7]. They have proposed a programme that enlarges on this and called for a massive global scale up of surgical capacity to close the gap on surgical accessibility.…”

“…Statistics show that sub Saharan Africa bears the greatest burden of surgical disease yet it has the lowest number of health professionals [6,7].…”