The Situation of Safe Surgery and Anaesthesia in Tanzania: A Systematic Review

Nyberger, Karolina; Jumbam, Desmond T.; Dahm, James; Maongezi, Sarah; Makuwani, Ahmed; Kapologwe, Ntuli; Nguhuni, Boniface; Mukhopadhay, Swagoto; Iverson, Katherine R.; Maina, Erastus; Kisakye, Steve; Mwai, Patrick; Hellar, Augustino; Barash, David; Reynolds, Cheri; Meara, John G.; Citron, Isabelle

doi:10.1007/s00268-018-4767-7

Cited by 36 publications

(45 citation statements)

References 31 publications

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“…This finding is similar to finding obtained in the study done by Nyberger et al [44] on the situation of safe surgery and anesthesia in Tanzania. There is a need to have adequate investment in the urban infrastructure at the same time having strong Public-Private Partnership framework that will help the people who are residing in urban areas to have subsidized cost of health care.…”

Section: Discussionsupporting

confidence: 92%

“…This will be needed for the Tanzanian setting as well to have a better outcome for surgeries conducted to the well-constructed health facilities. Surgery has become a global health priority with the adoption of the World Health Assembly Resolution 68.15 that called for the strengthening of emergency as well as essential surgical and anesthesia care as an integral component of Universal Health Coverage (UHC) [27,44].…”

Section: Discussionmentioning

confidence: 99%

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Development and upgrading of public primary healthcare facilities with essential surgical services infrastructure: a strategy towards achieving universal health coverage in Tanzania

Kapologwe

Meara

Kengia

et al. 2020

BMC Health Serv Res

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Background: Infrastructure development and upgrading to support safe surgical services in primary health care facilities is an important step in the journey towards achieving Universal Health Coverage (UHC). Quality health service provision together with equitable geographic access and service delivery are important components that constitute UHC. Tanzania has been investing in infrastructure development to offer essential safe surgery close to communities at affordable costs while ensuring better outcomes. This study aimed to understand the public sector's efforts to improve the infrastructure of primary health facilities between 2005 and 2019. We assessed the construction rates, geographic coverage, and physical status of each facility, surgical safety and services rendered in public primary health facilities. Methods: Data was collected from existing policy reports, the Services Availability and Readiness Assessment (SARA) tool (physical status), the Health Facility Registry (HFR), implementation reports on infrastructure development from the 26 regions and 185 district councils across the country (covering assessment of physical infrastructure, waste management systems and inventories for ambulances) and Comprehensive Emergence Obstetric Care (CEMONC) signal functions assessment tool. Data was descriptively analyzed so as to understand the distribution of primary health care facilities and their status (old, new, upgraded, under construction, renovated and equipped), and the service provided, including essential surgical services.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Development and upgrading of public primary healthcare facilities with essential surgical services infrastructure: a strategy towards achieving universal health coverage in Tanzania

Kapologwe

Meara

Kengia

et al. 2020

BMC Health Serv Res

Self Cite

View full text Add to dashboard Cite

Background: Infrastructure development and upgrading to support safe surgical services in primary health care facilities is an important step in the journey towards achieving Universal Health Coverage (UHC). Quality health service provision together with equitable geographic access and service delivery are important components that constitute UHC. Tanzania has been investing in infrastructure development to offer essential safe surgery close to communities at affordable costs while ensuring better outcomes. This study aimed to understand the public sector's efforts to improve the infrastructure of primary health facilities between 2005 and 2019. We assessed the construction rates, geographic coverage, and physical status of each facility, surgical safety and services rendered in public primary health facilities. Methods: Data was collected from existing policy reports, the Services Availability and Readiness Assessment (SARA) tool (physical status), the Health Facility Registry (HFR), implementation reports on infrastructure development from the 26 regions and 185 district councils across the country (covering assessment of physical infrastructure, waste management systems and inventories for ambulances) and Comprehensive Emergence Obstetric Care (CEMONC) signal functions assessment tool. Data was descriptively analyzed so as to understand the distribution of primary health care facilities and their status (old, new, upgraded, under construction, renovated and equipped), and the service provided, including essential surgical services.

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“…This finding is similar to finding obtained in the study done by Nyberger et al (2018) on the situation of safe surgery and anesthesia in Tanzania [45]. There is a need to have adequate investment in the urban infrastructure at the same time having strong Public-Private Partnership framework that will help the people who are residing in urban areas to have subsidized cost of health care.…”

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Development and upgrading of public primary healthcare facilities with essential surgical services infrastructure: a strategy towards achieving Universal Health Coverage in Tanzania

Kapologwe¹,

Meara

Kengia³

et al. 2020

Preprint

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Background: Infrastructure development and upgrading to support safe surgical services in primary health care facilities is an important step in the journey towards achieving Universal Health Coverage (UHC). This study aimed to understand the public sector's efforts to improve the infrastructure of primary health facilities between 2005 and 2019. We assessed the construction rates, geographic coverage, and physical status of each facility, surgical safety and services rendered in public primary health facilities. Methods : Data was collected from existing policy reports, the Services Availability and Readiness Assessment (SARA) tool (physical status), the Health Facility Registry (HFR), implementation reports on infrastructure development from the 26 regions and 185 district councils across the country and Comprehensive Emergence Obstetric Care (CEMONC) signal functions assessment tool. Data was descriptively analyzed so as to understand the distribution of primary health facilities and their status (old, new, upgraded, under construction, renovated and equipped), and the service provided, including surgical services. Results: Of 5,072 (in which 518 are Health Center and 4,554 are Dispensaries) existing primary health care facilities, the majority (46%) had a physical status of A (good state), 33% (1,693) had physical status of B (minor renovation needed) and the remaining facilities had physical status of C up to F (needing urgent major renovation or complete reconstruction). Only 33% (1,673) of all health facilities had water and 5.1% had telecommunication system. Between 2015 and 2019, a total of 419 (8.3%) health facilities (Consisting of 350 health centers and 69 District Hospitals) were either renovated or constructed and equipped to offer safe surgery facilities. Of all Health Centers only 115 (22.2%) were offering the CEMONC. Of these 115 health facilities, only 20 (17.4%) were offering the CEMONC with all 9-signal functions and only 17.4% were offering Blood transfusion services. Conclusion: Despite the achievements in infrastructure development and upgrading, still there is a high demand for good physical statuses and functioning of primary health facilities with capacity to offer essential and safe surgical services in the country also as an important strategy towards achieving UHC. Key Words: Infrastructure, primary health facilities, safe surgery and Universal Health Coverage

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“…Many developing countries, especially countries with longstanding conflicts such as Cambodia, have a critical shortage of healthcare workers and medical resources [1]. As an important part of medical services, anesthesia services are particularly susceptible to the level of socioeconomic development [2]. In low-income countries, anesthesia services are often provided by unqualified personnel, who are considered a low priority and lack the voice to request access to resources [3].…”

Section: Introductionmentioning

confidence: 99%

The challenge of safe anesthesia in developing countries: defining the problems in a medical center in Cambodia

Tao

Sokha²,

Yuan

2020

BMC Health Serv Res

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Background: The International Standards for a Safe Practice of Anesthesia (ISSPA) were developed on behalf of the World Federation of Societies of Anaesthesiologists and the World Health Organization. It has been recommend as an assessment tool that allows anesthetic providers in developing countries to assess their compliance and needs. This study was performed to describe the anesthesia service in one main public hospital during an 8-month medical mission in Cambodia and evaluate its anesthetic safety issues according to the ISSPA. Methods: We conduct a retrospective study involving 1953 patients at the Preah Ket Mealea hospital. Patient demographics, anesthetic techniques, and complications were reviewed according to the registers of the anesthetic services and questionnaires. The inadequacies in personnel, facilities, equipment, medications, and conduct of anesthesia drugs were recorded using a checklist based on the ISSPA.Results: A total of 1792 patients received general and regional anesthesia in the operating room, while 161 patients receiving sedation for gastroscopy. The patients' mean age was 45.0 ± 16.6 years (range, 17-87 years). The three most common surgical procedures were abdominal (52.0%; confidence interval [CI], 49.3-54.7), orthopedic (27.6%; CI, 25.2-29.9), and urological surgery (14.7%; CI,). General anesthesia, spinal anesthesia, and brachial plexus block were performed in 54.3% (CI, 51.7-56.8), 28.2% (CI, 25.9-30.5), and 9.4% (CI, 7.9-10.9) of patients, respectively. One death occurred. Twenty-six items related to professional aspects, monitoring, and conduct of anesthesia did not meet the ISSPA-recommended standards. A lack of commonly used drugs and monitoring equipment was noted, posing major threats to the safety of anesthesia practice, especially in emergency situations. Conclusions:This study adds to the scarce literature on anesthesia practice in low-and middle-income countries such as Cambodia. Future medical assistance should help to strengthen these countries' inadequacies, allowing for the adoption of international standards for the safe practice of anesthesia.

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The Situation of Safe Surgery and Anaesthesia in Tanzania: A Systematic Review

Cited by 36 publications

References 31 publications

Development and upgrading of public primary healthcare facilities with essential surgical services infrastructure: a strategy towards achieving universal health coverage in Tanzania

Development and upgrading of public primary healthcare facilities with essential surgical services infrastructure: a strategy towards achieving universal health coverage in Tanzania

Development and upgrading of public primary healthcare facilities with essential surgical services infrastructure: a strategy towards achieving Universal Health Coverage in Tanzania

The challenge of safe anesthesia in developing countries: defining the problems in a medical center in Cambodia

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