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World J Surg. 2018 Aug;42(8):2303-2313. doi: 10.1007/s00268-018-4485-1.

Access to Safe, Timely, and Affordable Surgical Care in Uganda: A Stratified Randomized Evaluation of Nationwide Public Sector Surgical Capacity and Core Surgical Indicators.

Author information

1
Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA. kalbutt@partners.org.
2
Department of Surgery, Massachusetts General Hospital (MGH), Boston, MA, USA. kalbutt@partners.org.
3
Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA.
4
David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
5
Mbarara University of Science and Technology (MUST), Mbarara, Uganda.
6
Ministry of Health (MOH), Kampala, Uganda.
7
Uganda Martyrs University (UMU), Nkozi, Uganda.
8
Department of Surgery, Massachusetts General Hospital (MGH), Boston, MA, USA.
9
Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.

Abstract

BACKGROUND:

Access to safe surgery is critical to health, welfare, and economic development. In 2015, the Lancet Commission on Global Surgery recommended that all countries collect surgical indicators to lend insight into improving surgical care. No nationwide high-quality data exist for these metrics in Uganda.

METHODS:

A standardized quantitative hospital assessment and a semi-structured interview were administered to key stakeholders at 17 randomly selected public hospitals. Hospital walk-throughs and retrospective reviews of operative logbooks were completed.

RESULTS:

This study captured information for public hospitals serving 64.0% of Uganda's population. On average, <25% of the population had 2 h access to a surgically capable facility. Hospitals averaged 257 beds/facilities and there were 0.2 operating rooms per 100,000 people. Annual surgical volume was 144.5 cases per 100,000 people per year. Surgical, anesthetic, and obstetrician physician workforce density was 0.3 per 100,000 people. Most hospitals reported having electricity, oxygen, and blood available more than half the time and running water available at least three quarters of the time. In total, 93.8% of facilities never had access to a CT scan. Sterile gloves, nasogastric tubes, and Foley catheters were frequently unavailable. Uniform outcome reporting does not exist, and the WHO safe surgery checklist is not utilized.

CONCLUSION:

The Ugandan public hospital system does not meet LCoGS targets for surgical access, workforce, or surgical volume. Critical policy and programmatic developments are essential to build surgical capacity and facilitate provision of safe, timely, and affordable surgical care. Surgery must become a public health priority in Uganda and other low resource settings.

PMID:
29368021
DOI:
10.1007/s00268-018-4485-1
[Indexed for MEDLINE]

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