The Impact of Launching Surgery at the District Level in Niger

Abstract

Background In 2005, the Ministry of Health in association with the Faculty of Medicine of Niamey decided to launch surgery at the district hospital (DH) level as part of the health strategy for the country. Surgical procedures were provided by general practitioners who received 12 months of training in basic surgery. Methods Whereas the initiative was launched nationwide, we chose randomly to study the region of Dosso during a 1-year time period of January 2007 to December 2007 in the three district hospitals as well as the regional hospital of Dosso.Results During the course of 1 year, 544 patients received operations in the three DHs, of which 37.9% (n = 206) were emergent and 62.1% (n = 338) were elective. The most common emergent interventions were cesarean sections (70%) and uterine ruptures (7.8%). For elective surgeries, hernia repairs comprised 80.8% of the cases. The mortality rate of emergent surgeries was 7.3 and 0% in the cases of elective surgeries. Of note, there was a large reduction in transfers to the regional hospital: 52% compared to 2006 and 82% compared to 2005. In 66.1% of the transfers, the cases consisted of fractures, and in 10.4% of abdominal trauma and critical thoracic emergencies. Further study of this initiative has highlighted other challenges, including that of human resources, equipment maintenance, provision of consumables, and the need for continued training. Conclusions Results from this governmental initiative to provide surgery in rural district hospitals by general practitioners are promising and encouraging. In the rural district of Dosso, there have been no deaths from elective surgery, and the number of surgical transfers to the regional hospital has drastically diminished.

Rural Surgery in Niger: A Multicentric Study in 21 District Hospitals

“…Skilled manpower for health care is a serious problem in developing countries. World Health Organization (WHO) reported that Africa contributes about 25 % of the world's burden of disease but possessed only 1.3 % of qualified health professional [1,2]. The lack of human resources to perform surgery in sub-Saharan Africa is due to the brain drain to Europe and a shortage of teaching and training facilities adapted to the emergency surgery needs [3].…”

“…Based on lessons from the failure of the 1995 program, the Faculty of Medicine agreed to increase the number of trainees and to improve teaching methods. The certificate called "Capacity of District Surgery" was created for students who were government physicians who finished 12 months of training [2]. The diploma of district surgery also provided a bonus on their annual salary as additional incentive.…”

“…In Niger, basic emergency surgery is performed by physicians but other African countries have chosen to train non physicians to perform some emergency procedures like cesarean section and laparotomies (assistant medical officers) [7][8][9]. In Ethiopia, the program consists of training general practitioner in surgical skills for a period of 6 months [2,10]. During this analysis, a problem of repartition of human resources was observed as two thirds of the DHs have two to three CDSs at one's disposal, number which permits to conveniently perform programmed surgical activities, but in other DHs only one CDS is available; in such circumstances, surgery will totally stop in case of its nonavailability.…”

“…Niger, a low-income country, needs an alternative to solve this manpower issue. Mobile surgical camps were initiated since 1974; however, this policy was abandoned because of its high cost [2]. In 2004, the Ministry of Health (MOH) became involved in the regional development of district surgeons, in order to strengthen health systems and increase access to surgery in rural area.…”

“…The number of surgeons in the developing countries is significantly low. Some authors report that general practitioners (GP) handle 75 % of all surgical procedures in rural area; these nonspecialists, GP, and sometimes senior nurses received a special training to perform these specific tasks [1][2][3][4]. Niger, a low-income country, needs an alternative to solve this manpower issue.…”