TRIP

Human resource and funding constraints for essential surgery in district hospitals in Africa: a retrospective cross-sectional survey.

PLoS medicine, 2010

Human resource and funding constraints for essential surgery in district hospitals in Africa: a retrospective cross-sectional survey.
BACKGROUND: There is a growing recognition that the provision of surgical services in low-income countries is inadequate to the need.
While constrained health budgets and health worker shortages have been blamed for the low rates of surgery, there has been little empirical data on the providers of surgery and cost of surgical services in Africa.
This study described the range of providers of surgical care and anesthesia and estimated the resources dedicated to surgery at district hospitals in three African countries.
METHODS AND FINDINGS: We conducted a retrospective cross-sectional survey of data from eight district hospitals in Mozambique, Tanzania, and Uganda.
Most of the health workers were nurses (77.5%), followed by mid-level providers (MLPs) not trained to provide surgical care (7.8%), and MLPs trained to perform surgical procedures (3.8%).
Most major surgical procedures were performed by doctors (54.6%), however over one-third (35.9%) were done by MLPs.
Of the total operating costs, only 7% to 14% was allocated to surgical care, the majority of which was for obstetric surgery.
These costs represent a per capita expenditure on surgery ranging from US$0.05 to US$0.14 between the eight hospitals.
CONCLUSION: African countries have adopted different policies to ensure the provision of surgical care in their respective district hospitals.