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

Abstract

Background: Surgery is an essential component of health care, yet it has usually been overlooked in public health across the world. Objectives: This study aimed to perform a situational analysis of essential surgical care management at district hospitals in Iran. Materials and Methods: This research was a descriptive and cross-sectional study performed at 42 first-referral district hospitals of Iran in 2013. The World Health Organization (WHO) Tool for the situational analysis of emergency and essential care was used for data collection in four domains of facilities and equipment, human resources, surgical interventions, and infrastructure. Data analysis was conducted using simple descriptive statistical methods. Results: In this study, 100% of the studied hospitals had oxygen cylinders, running water, electricity, anesthesia machines, emergency departments, archives of medical records, and X-ray machines. In 100% of the surveyed hospitals, specialists in surgery, anesthesia, and obstetrics and gynecology were available as full-time staff. Life-saving procedures were performed in the majority of the hospitals. Among urgent procedures, neonatal surgeries were conducted in 14.3% of the hospitals. Regarding non-urgent procedures, acute burn management was conducted in 38.1% of the hospitals. Also, a few other procedures such as cricothyrotomy and foreign body removal were performed in 85.7% of the hospitals. Conclusions:The results indicated that suitable facilities and equipment, human resources, and infrastructure were available in the district hospitals in Iran. These findings showed that there is potential for the district hospitals to provide care in a wider spectrum. BackgroundPreliminary estimates show that 11% of the global burden of disease is manageable by surgery (1). However, surgical procedures have their own complications and risks. Even with conservative estimates, each year 7 million people suffer from complications caused by surgery, while probably half of them are preventable. Studies have also shown that the rate of major complications caused by surgery for hospitalized patients in developed countries is 3 -6%, accounting for 0.4 -0.8% of total mortality, as opposed to 5 -10% in developing countries (2). What is more, the performance of organizations providing surgical care in low-and middle-income countries (LMICs) is not satisfactory (3). Only 3.5% of major surgical procedures are performed in low-income countries, while they account for 1.3% of the world's population (4).In addition to the quality of surgical procedures, the costeffectiveness of surgeries is a very important issue which is different between countries. Available evidence suggests that the cost-effectiveness of essential surgical care in LMICs is not appropriate (1). Furthermore, in LMICs surgical knowledge is not sufficient. It seems that although surgery is an integral component of health care, it is generally neglected in these countries (5, 6). To tackle the above problems and reduce inequity in the quality and quan...