Surgical services in low-income and middle-income countries
Division of Orthopedic Surgery, Childrens Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. The Lancet
(Impact Factor: 45.22).
10/2007; 370(9592):1013-5. DOI: 10.1016/S0140-6736(07)61457-3
Available from: Ayobami Akenroye
- "Author(s), year of publication Country (if specified) Author(s), year of publication Country (if specified) Archampong, 2006 Leow et al., 2011 Sierra Leone Arnold, 2012 Linden et al., 2012 Uganda Aswani et al., 2012 Loefler, 2004 Bickler et al., 2002 Luboga et al., 2009 Bickler et al., 2010 (LMIC) Luboga et al., 2010 Uganda Calisti et al., 2010 Eritrea Meo et al., 2006 Sudan Cameron et al., 2010 Guyana Mock et al., 2012 Chirdan et al., 2010 (Africa) Natuzzi et al., 2011 Solomon Islands Contini, 2007 Ozgediz et al., 2008 Daar et al., 2007 Ozgediz et al., 2009 (LMIC) Derbew et al., 2006 (East Africa) Perkins et al., 2010 Duda, 2007 Petroze et al., 2012 Rwanda Dunne et al., 2011 Quansah et al., 2008 Ghana Farner et al., 2008 Riviello et al., 2010 Figus et al., 2009 Various developing countries Rogers, 2006 Gosselin et al., 2011 Shilpakar, 2011 Nepal Haglund et al., 2011 Uganda Spiegel et al., 2007 Haynes et al., 2009 Syed-Abdul et al., 2012 Higginson et al., 2012 Tollefson et al., 2012 Jacobs, 2010 Udwadia et al., 2008 India Kingham, 2009 Sierra Leone Vos, 2009 Kruk et al., 2007 Weiser et al., 2008 Kushner et al., 2010 Sierra Leone Zafar et al., 2011 Pakistan Kwon et al., 2012 "
Available from: heapol.oxfordjournals.org
- "This is consistent with the overall goal of developing a health system to improve health, and strengthening the system's ability to respond to the needs of its population. The need to develop adequate emergency and surgical services is increasingly evident as surgically treatable diseases, such as hernia repair, become a greater public health burden (Spiegel and Gosselin 2007; Galukande et al. 2010). The WHO acknowledged the need to provide essential surgical services when it began the Emergency and Essential Surgical Care project. "
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ABSTRACT: The effort to increase access to emergency and surgical care in low-income countries has received global attention. While most of the literature on this issue focuses on workforce challenges, it is critical to recognize infrastructure gaps that hinder the ability of health systems to make emergency and surgical care a reality.
This study reviews key barriers to the provision of emergency and surgical care in sub-Saharan Africa using aggregate data from the Service Provision Assessments and Demographic and Health Surveys of five countries: Ghana, Kenya, Rwanda, Tanzania and Uganda. For hospitals and health centres, competency was assessed in six areas: basic infrastructure, equipment, medicine storage, infection control, education and quality control. Percentage of compliant facilities in each country was calculated for each of the six areas to facilitate comparison of hospitals and health centres across the five countries.
The percentage of hospitals with dependable running water and electricity ranged from 22% to 46%. In countries analysed, only 19-50% of hospitals had the ability to provide 24-hour emergency care. For storage of medication, only 18% to 41% of facilities had unexpired drugs and current inventories. Availability of supplies to control infection and safely dispose of hazardous waste was generally poor (less than 50%) across all facilities. As few as 14% of hospitals (and as high as 76%) among those surveyed had training and supervision in place.
No surveyed hospital had enough infrastructure to follow minimum standards and practices that the World Health Organization has deemed essential for the provision of emergency and surgical care. The countries where these hospitals are located may be representative of other low-income countries in sub-Saharan Africa. Thus, the results suggest that increased attention to building up the infrastructure within struggling health systems is necessary for improvements in global access to medical care.
Available from: PubMed Central
- "In 2005, the WHO established the Global Initiative for Emergency and Essential Surgical Care (GIEESC) with the aim of improving collaborations among organizations and agencies involved in reducing morbidity and mortality from surgical conditions . Further discussions have appeared recently in both medical and surgical journals [26, 27], and the second edition of the World Bank’s influential Disease Control Priorities in Developing Countries included a chapter on surgery . The Bellagio Conference in June 2007 brought together leaders in surgery, anesthesia, obstetrics, health policy, and health economics from Africa, Europe, and the United States, who collectively concluded that a significant proportion of the global burden of disease is surgical, that with investments in infrastructure and training a majority of surgical disease can be treated or prevented at first-level referral centers, and that the integration of surgical services with primary health care services will be essential for prevention and referral efforts . "
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ABSTRACT: Although surgical care has not been seen as a priority in the international public health community, surgical disease constitutes a significant portion of the global burden of disease and must urgently be addressed. The experience of the nongovernmental organizations Partners In Health (PIH) and Zanmi Lasante (ZL) in Haiti demonstrates the potential for success of a surgical program in a rural, resource-poor area when services are provided through the public sector, integrated with primary health care services, and provided free of charge to patients who cannot pay. Providing surgical care in resource-constrained settings is an issue of global health equity and must be featured in national and international discussions on the improvement of global health. There are numerous training, funding, and programmatic considerations, several of which are raised by considering the data from Haiti presented here.
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