Improving District Hospital Surgical Capacity in Resource Limited Settings: Challenges and Lessons From South Africa Comment on "Improving Access to Surgery through Surgical Team Mentoring – Policy Lessons From Group Model Building with Local Stakeholders in Malawi"

Abstract

Strengthening surgical capacity of district hospitals (DHs) in low- and middle-income countries (LMICs) has been recognised globally as key to improving equitable access to surgical care. This commentary considers the benefits and challenges of surgical mentoring in South Africa and applies the lessons learned to other low-resource settings. Surgical team mentoring programmes require consideration of all stakeholders involved, with strong relationships between mentors and mentees, and the possible establishment of roaming district surgical teams. Other components of a surgical ecosystem must also be strengthened including defining a DH surgical package of care, ensuring strong referral systems through a hub and spoke model, and routine monitoring and evaluation. These recommendations have the potential to strengthen surgical capacity in DHs in low-resource settings which is critical to achieving health for all.

Evidence-Informed Surgical Systems Strengthening with Meaningful Stakeholder Involvement in Low-Resource Settings: A Response to Recent Commentaries

“…They also acknowledge the potential application of the findings, the transfer of lessons learned and proposed scenarios for surgical team mentoring, along with the associated policy implications, in other settings, for example South Africa. 2 Moreno et al go as far as suggesting that the mentoring model evaluated in the SURG-Africa project in Malawi may serve as an example for other specialities (ie, family medicine in Colombia). 3 Several commentaries outline the elements required to make surgical team mentoring work in practice: for example, strengthening the entire surgical ecosystem, 2 defining district hospital surgical service packages, 2 clarifying the value of surgical task-shifting, 4 covering the additional cost of increased surgical output, 5,6 overcoming disincentives to surgical mentoring, 5 and appropriate governance and regulatory processes so as to ensure quality and accountability.…”

“…1 Radboud University Medical Centre, Nijmegen, The Netherlands. 2 Institute of Global Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland. 3 Global Surgery Policy Unit, LSE Health, London School of Economics and Political Science, London, UK.…”

Beyond Policy: Strengthening District Level Access to Surgery Is Critical to Achieving Surgical Equity in Universal Health Coverage Comment on "Improving Access to Surgery Through Surgical Team Mentoring – Policy Lessons From Group Model Building With Local Stakeholders in Malawi"

“…This coordinator, as the authors state, can now be the 'glue' that binds the districts and the central hospital, creating the hub and spoke model that was mentioned. 6 The authors also note field visits of up to four times per year with a corresponding 5% cancellation rate compared with six (25% cancellation rate). This roughly translates to one field visit every three months, with variable patient load available.…”

“…This coordinator, as the authors state, can now be the ‘glue’ that binds the districts and the central hospital, creating the hub and spoke model that was mentioned. 6 …”

“…Several strategies that have been brought up reflect current global recommendations – district level packages of care, hub and spoke referral networks, monitoring and evaluation, 6 and in the current article, introducing a financing mechanism through which district hospitals are rewarded for more surgical procedures done. 1 While suggestions on increasing financial incentives for surgical care at the district level may increase the number of surgical care provision, for countries in the low-income bracket who have serious non-surgical competing priorities for resources, this may be not be feasible.…”