Retrospective review of Surgical Availability and Readiness in 8 African countries

Abstract

ObjectivesThe purpose of this study was to assess surgical availability and readiness in 8 African countries using the WHO's Service Availability and Readiness Assessment (SARA) tool.SettingWe analysed data for surgical services, including basic and comprehensive surgery, comprehensive obstetric care, blood transfusion, and infection prevention, obtained from the WHO's SARA surveys in Sierra Leone, Uganda, Mauritania, Benin, Zambia, Burkina Faso, Democratic Republic of Congo and Togo.Primary and secondary outcome measuresAmong the facilities that were expected to offer surgical services (N=3492), there were wide disparities between the countries in the number of facilities per 100 000 population that reported offering basic surgery (1.0–12.1), comprehensive surgery (0.1–0.8), comprehensive obstetric care (0.1–0.8) and blood transfusion (0.1–0.8). Only 0.1–0.3 facilities per 100 000 population had all three bellwether procedures available, namely laparotomy, open fracture management and caesarean section. In all the countries, the facilities that reported offering surgical services generally had a shortage of the necessary items for offering the services and this varied greatly between the countries, with the facilities having on average 27–53% of the items necessary for offering basic surgery, 56–83% for comprehensive surgery, 49–72% for comprehensive obstetric care and 54–80% for blood transfusion. Furthermore, few facilities had all the necessary items present. However, facilities that reported offering surgical services had on average most of the necessary items for the prevention of infection.ConclusionsThere are important gaps in the surgical services in the 8 African countries surveyed. Efforts are therefore urgently needed to address deficiencies in the availability and readiness to deliver surgical services in these nations, and this will require commitment from multiple stakeholders. SARA may be used to monitor availability and readiness at regular intervals, which will enable stakeholders to evaluate progress and identify gaps and areas for improvement.

Who accesses surgery at district level in sub‐Saharan Africa? Evidence from Malawi and Zambia

“…Table shows the percentage breakdown for the most common procedures among the three bellwether categories – obstetric, general and trauma‐related surgery in Malawi and Zambia. Among the five types of hernias, inguinal and femoral hernia repairs, together, were the most common, accounting for 87.7% of hernia repairs in Malawi and 79.4% in Zambia.…”

Evaluation of a surgical training programme for clinical officers in Malawi

“…Therefore, MDs can be considered a valid comparator when the quality of service is measured. The analysis was undertaken for hernia procedures, which served as an example of the most commonly performed general surgical procedure at district level in sub‐Saharan Africa. Before and after the training, differences in means of self‐reported surgical confidence scores in performing operations unsupervised, measured on a scale from 0 to 20, were compared using paired t tests.…”

Health systems readiness to provide geriatric friendly care services in Uganda: a cross-sectional study

“…Readiness is the ability of a health facility to provide a given health service (27), and for geriatric care, the WHO's 2008 Age-friendly Primary Health Care Centres Toolkit (28) provides an insight on which key systems and items that should be in place if a primary health care facility is to offer geriatric friendly care services. WHO's "the measuring service availability and readiness health assessment (SARA) methodology for monitoring health systems strengthening" (29) The SARA methodology has effectively been used in resource-limited countries to assess: general health facility readiness (31), progress towards universal health coverage (32), maternal and child health services and non-communicable diseases in Bangladesh (33,34), surgical services in Africa (35), and readiness of Ugandan health services for the management of outpatients with chronic diseases (36). That said, based on a rigorous internet-based review of literature search, there are no studies that have been conducted to assess the readiness of public health facilities to provide geriatric friendly services in low-and middle-income countries.…”