The role of family physicians in emergency and essential surgical care in the district health system in South Africa

Chu, Kathryn; Reid, Steve; Hendriks, H. Jurgens; Nash, Jenny; Lomas, Vanessa; Coetzee, Francois; Mash, Robert

doi:10.4102/safp.v62i1.5117

Cited by 5 publications

(5 citation statements)

References 11 publications

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“…The 2015 World Health Assembly Declaration 68.15 which stated essential and emergency surgical care as a key component to Universal Health Coverage, placed the district hospital as the backbone of achieving quality surgical access for all [ 31 ]. The lack of district hospital surgical capacity in South Africa is a critical limitation to improving surgical capacity and mitigating this barrier, and should be one of the critical focuses of any national or provincial surgical improvement strategy [ 32 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

Prioritising and mapping barriers to achieve equitable surgical care in South Africa: a multi-disciplinary stakeholder workshop

Quene

Smith

Odland

et al. 2022

Global Health Action

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Background Surgical healthcare in South Africa is inequitable with a considerable lack of resources in the public health sector. Identifying barriers to care and creating research priorities to mitigate these barriers can contribute to strategic interventions to improve equitable access to quality surgical care. Objective To use the Four Delays Framework to map barriers to surgical care and identify priorities to achieve equitable and timely access to quality surgical care in South Africa. Methods A multi-disciplinary stakeholder workshop was held in Cape Town, South Africa in January 2020. A Four Delays Framework (delays in seeking care, reaching care, receiving care, and remaining in care) was used to identify barriers that occur at each delay and the top 10 priorities for intervention. Barriers were categorised into overarching themes and schematically mapped. Results Thirty-four stakeholders including health service users, health service providers, and community members participated in this exercise. In total, 34 barriers were identified with 73 connections to various delays. Specifically, 14 barriers were related to delays in seeking care, 11 were related to delays in reaching care, 20 were related to delays in receiving care, and 28 were related to delays in remaining in care. The highest priority barriers across the delays were Lack of service provider’s knowledge, training and experience , and Limited surgical outreach . The barrier Lack of decentralised services was related to all four delays. Barriers were interconnected and potentially reinforcing. Conclusions This workshop is the first of its kind to generate evidence on the delays to surgical care in South Africa. Mapping crucial interconnected, potentially reinforcing barriers, and priority interventions demonstrated how a multifaceted approach may be required to address delays to access. Further research focused on the identified priorities will contribute to efforts to promote equitable access to quality surgical care in South Africa.

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Section: Discussionmentioning

confidence: 99%

Prioritising and mapping barriers to achieve equitable surgical care in South Africa: a multi-disciplinary stakeholder workshop

Quene

Smith

Odland

et al. 2022

Global Health Action

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“…Surgery is a clinical domain in the training of South African family physicians [28]. Family physicians have a responsibility for access to, and the quality of, surgical services in their districts along with working with specialists and subspecialists at higherlevel hospitals [29][30][31]. District hospitals within South Africa can serve as adequate training sites for family physicians in nationally expected skills in surgery, obstetrics and anaesthetics [32][33].…”

Section: Discussionmentioning

confidence: 99%

Estimating the Specialist Surgical Workforce Density in South Africa

Tiwari

Chikte

Chu

2021

Annals of Global Health

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Background: South Africa is an upper middle-income country with inequitable access to healthcare. There is a maldistribution of doctors between the private and public sectors, the latter which serves 86% of the population but has less than half of the human resources.Objective: The objective of this study was to estimate the specialist surgical workforce density in South Africa.Methods: This was a retrospective record-based review of the specialist surgical workforce in South Africa as defined by registration with the Health Professionals Council of South Africa for three cadres: 1) surgeons, and 2) anaesthesiologists, and 3) obstetrician/gynaecologists (OBGYN).

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“…Some already perform DH surgery and others have expressed a willingness to upskill but fear criticism from surgeons if complications arise. 6 A mentoring programme would be a mutually beneficial way to provide support and establish trust between themselves and surgeon mentors. Whilst building relationships with family physicians may be beneficial, DHs in South Africa are often staffed by community service or junior doctors who are re-assigned after one year.…”

Section: Stakeholder Considerationsmentioning

confidence: 99%

“…Historically, delivery of DH surgical care in this country has been limited, but more recent recognition of the importance of decentralisation of services to improve access to timely and quality surgical care has taken place. 6 Challenges to increasing the capacity of rural surgical care in South Africa include lack of training, communication, and support from regional hospitals; skills-resource mismatch; and an ill-defined DH role in surgical provision. 2 We consider some of the challenges identified in the South African context which could be applied when utilising strategies such as surgical team mentoring to strengthen DH surgical capacity in other LMICs.…”

Section: Introductionmentioning

confidence: 99%

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"

Bust

Chu

2022

Int J Health Policy Manag

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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.

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The role of family physicians in emergency and essential surgical care in the district health system in South Africa

Cited by 5 publications

References 11 publications

Prioritising and mapping barriers to achieve equitable surgical care in South Africa: a multi-disciplinary stakeholder workshop

Prioritising and mapping barriers to achieve equitable surgical care in South Africa: a multi-disciplinary stakeholder workshop

Estimating the Specialist Surgical Workforce Density in South Africa

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"

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