Improving District Hospital Surgical Capacity in Resource Limited Settings: Challenges and Lessons From South Africa; Comment on “Improving Access to Surgery through Surgical Team Mentoring – Policy Lessons From Group Model Building with Local Stakeholders in Malawi”

Document Type : Commentary

Authors

1 Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa

2 Department of Surgery, University of Botswana, Gaborone, Botswana

Abstract

Strengthening surgical capacity of district hospitals (DHs) in low- and middle-income countries (LMICs) has been recognised globally as key to improving equitable access to surgical care. This commentary considers the benefits and challenges of surgical mentoring in South Africa and applies the lessons learned to other low-resource settings. Surgical team mentoring programmes require consideration of all stakeholders involved, with strong relationships between mentors and mentees, and the possible establishment of roaming district surgical teams. Other components of a surgical ecosystem must also be strengthened including defining a DH surgical package of care, ensuring strong referral systems through a hub and spoke model, and routine monitoring and evaluation. These recommendations have the potential to strengthen surgical capacity in DHs in low-resource settings which is critical to achieving health for all.

Keywords


  • epublished Author Accepted Version: January 29, 2022
  • epublished Final Version: February 14, 2022
  1. Broekhuizen H, Ifeanyichi M, Mwapasa G, et al. Improving access to surgery through surgical team mentoring–policy lessons from group model building with local stakeholders in Malawi. Int J Health Policy Manag. 2021. doi:34172/ijhpm.2021.78
  2. Chu KM, Naidu P, Hendriks HJ, et al. Surgical care at rural district hospitals in low- and middle-income countries: an essential component of universal health coverage. Rural Remote Health. 2020;20(2):5920. doi:22605/rrh5920
  3. Price R, Makasa E, Hollands M. World Health Assembly Resolution WHA68.15: "strengthening emergency and essential surgical care and anesthesia as a component of universal health coverage"—addressing the public health gaps arising from lack of safe, affordable and accessible surgical and anesthetic services. World J Surg. 2015;39(9):2115-2125. doi:1007/s00268-015-3153-y
  4. Mukora R, Charalambous S, Dahab M, Hamilton R, Karstaedt A. A study of patient attitudes towards decentralisation of HIV care in an urban clinic in South Africa. BMC Health Serv Res. 2011;11:205. doi:1186/1472-6963-11-205
  5. Bhuiyan MM, Mavhungu R, Machowski A. Provision of an emergency theatre in tertiary hospitals is cost-effective: audit and cost of cancelled planned elective general surgical operations at Pietersburg Hospital, Limpopo province, South Africa. S Afr Med J. 2017;107(3):239-242. doi:7196/SAMJ.2017.v107i3.10687
  6. Chu K, Naidu P, Reid S, et al. The role of family physicians in emergency and essential surgical care in the district health system in South Africa. S Afr Fam Pract (2004). 2020;62(1):e1-e3. doi:4102/safp.v62i1.5117
  7. Kruk ME, Pereira C, Vaz F, Bergström S, Galea S. Economic evaluation of surgically trained assistant medical officers in performing major obstetric surgery in Mozambique. BJOG. 2007;114(10):1253-1260. doi:1111/j.1471-0528.2007.01443.x
  8. Oboirien K, Harris B, Goudge J, Eyles J. Implementation of district-based clinical specialist teams in South Africa: analysing a new role in a transforming system. BMC Health Serv Res. 2018;18(1):600. doi:1186/s12913-018-3377-2
  9. Naidu P, Chu KM. District hospital surgical capacity in Western Cape province, South Africa: a cross-sectional survey. S Afr Med J. 2021;111(4):343-349. doi:7196/SAMJ.2021.v111i4.15281
  10. Gilson L. Introduction to health policy and systems research. In: Health Policy and Systems Research: A Methodology Reader. Geneva: Alliance for Health Policy and System Research, WHO; 2012.
  11. Chu KM, Duvenage R. A call to action: translating procedural baskets into improved surgical capacity at the district hospital. World J Surg. 2021;45(2):378-379. doi:1007/s00268-020-05827-1
  12. Department of Health. A District Hospital Service Package for South Africa: A Set of Norms and Standards. Pretoria: Department of Health; 2002. http://www.kznhealth.gov.za/norms.pdf. Accessed September 30, 2021.
  13. World Bank Group. Improving Linkages and Referrals to the Broader Health System: For Equitable Care Amidst Rapid Growth and Urbanization. Washington, DC: World Bank; 2018.
  14. Ganasegeran K, Renganathan P, Rashid A, Al-Dubai SA. The m-Health revolution: exploring perceived benefits of WhatsApp use in clinical practice. Int J Med Inform. 2017;97:145-151. doi:1016/j.ijmedinf.2016.10.013
  15. Anstey Watkins JOT, Goudge J, Gómez-Olivé FX, Griffiths F. Mobile phone use among patients and health workers to enhance primary healthcare: a qualitative study in rural South Africa. Soc Sci Med. 2018;198:139-147. doi:1016/j.socscimed.2018.01.011
Volume 11, Issue 10
October 2022
Pages 2361-2364
  • Receive Date: 12 November 2021
  • Revise Date: 24 January 2022
  • Accept Date: 26 January 2022
  • First Publish Date: 29 January 2022