Capacity for Surgical Care at the District Hospital Level in LMICs

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Capacity for Surgical Care at the District
Hospital Level in LMICs
David Spiegel, Adam Kushner Steve Bickler,
Richard Gosselin, Meena Cherian, and Luc Noel
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World Health Report 2008

• Health systems are developing in directions that
  contribute little to equity and social justice
  and fail to get the best health outcomes for
  their money

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Components of Health Systems
Stewardship

• Capacity
• Infrastructure
• Physical Resources
• Human Resources

Financing
Resource Generation

• Quality
• Training
• Monitoring

Service Provision
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? Access to Surgical Care

• Geographic Constraints

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? Access to Surgical Care

• Lack of infrastructure
• Buildings
• Information, Communication
• Transport
• Lack of physical resources

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? Access to Surgical Care

• Deficiencies in Health Workforce
• Number (Brain Drain)
• Distribution (Urban vs. Rural)
• Lack of training

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Afghanistan Kandahar Province

• Mirwais Regional Hospital
• 1 surgeon, 2 Anaesthesia, 7 OB/GYN, 10 general
  doctors performing surgery
• Full spectrum of essential procedures

• Spin Boldak
• 1 General Doctor
• 1 Anesthetist
• gt 50 km for referral
• Wound care, DC, male circum, abscess drainage

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Capacity for Surgery at District Hospitals in
LICs

• WHO essential surgical questionnaire
• Infrastructure and Physical resources

Kushner AL, Cherian MN, Noel L, Spiegel DA. Arch
Surg, in Press
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Capacity for Surgery at District Hospitals in
LICs

• 130 Facilities in 9 countries
• Afghanistan, Mongolia, Sierra Leone, Sri Lanka,
  The Gambia, Sao Tome and Principe, Liberia,
  Tanzania

Kushner AL, Cherian MN, Noel L, Spiegel DA. Arch
Surg, in Press
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Kushner AL, Cherian MN, Noel L, Spiegel DA. Arch
Surg, in Press
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Kushner AL, Cherian MN, Noel L, Spiegel DA. Arch
Surg, in Press
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Kushner AL, Cherian MN, Noel L, Spiegel DA. Arch
Surg, in Press
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Kushner AL, Cherian MN, Noel L, Spiegel DA. Arch
Surg, in Press
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The Future Defining and Monitoring Capacity

• Comprehensive Facilities Assessment at district
  level
• WHOs Service Availability Mapping with surgical
  questionnaire
• Strengthen health information systems

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Data collected using questionnaires on PDAs by
district health teams
PDA is synchronized with PC for data transfer
Data is analyzed and maps produced using WHO's
Health Mapper software
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Number of Doctors (Zambia)
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Availability of C-Sections (Zambia)
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Thank You !