Evidence-Driven Policies for Sustainably Scaling Up Surgical Task-Sharing in Malawi; 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 Department of Policy and Advocacy, Operation Smile, Virginia Beach, VA, USA

2 Operation Smile Ghana, Accra, Ghana

3 Operation Smile DR Congo, Kinshasa, Democratic Republic of Congo

4 Royal London Hospital, London, UK

5 Department of Neurosurgery, Queen Elizabeth Central Hospital, Blantyre, Malawi

Abstract

This commentary discusses an article by Broekhuizen et al which assesses policy options for scaling up the SURG-Africa surgical team mentoring program in Malawi to increase access to surgical care. In modeling these scenarios, the authors assess the cost of scaling up surgical teams mentoring and the impacts of scaling the program on district hospitals (DHs) and central hospitals (CHs). The additional costs borne by DHs when increasing surgical volume remains a significant issue identified by the authors and could ultimately determine the success of the program. The piece indirectly advocates for an increased role for task-shifting. The Ministry of Health of Malawi will have to ensure the appropriate governance and regulatory processes are in place to maintain quality and accountability.

Keywords


  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. Sgrò A, Al-Busaidi IS, Wells CI, et al. Global surgery: a 30-year bibliometric analysis (1987-2017). World J Surg. 2019;43(11):2689-2698. doi:1007/s00268-019-05112-w
  3. Jumbam DT, Durnwald L, Munabi NC, Ayala R. Implementation science: a missing link in global surgery. East Cent Afr J Surg. 2021;26(2):45-48.
  4. Truché P, Shoman H, Reddy CL, et al. Globalization of national surgical, obstetric and anesthesia plans: the critical link between health policy and action in global surgery. Global Health. 2020;16(1):1. doi:1186/s12992-019-0531-5
  5. Muhirwa E, Habiyakare C, Hedt-Gauthier BL, et al. Non-obstetric surgical care at three rural district hospitals in Rwanda: more human capacity and surgical equipment may increase operative care. World J Surg. 2016;40(9):2109-2116. doi:1007/s00268-016-3515-0
  6. Choo S, Perry H, Hesse AA, et al. Assessment of capacity for surgery, obstetrics and anaesthesia in 17 Ghanaian hospitals using a WHO assessment tool. Trop Med Int Health. 2010;15(9):1109-1115. doi:1111/j.1365-3156.2010.02589.x
  7. Pittalis C, Brugha R, Gajewski J. Surgical referral systems in low- and middle-income countries: a review of the evidence. PLoS One. 2019; 14(9):e0223328. doi:1371/journal.pone.0223328
  8. Nyberger K, Jumbam DT, Dahm J, et al. The situation of safe surgery and anaesthesia in Tanzania: a systematic review. World J Surg. 2019; 43(1):24-35. doi:1007/s00268-018-4767-7
  9. Liu Y, Zhang Y, Liu Z, Wang J. Gaps in studies of global health education: an empirical literature review. Glob Health Action. 2015;8:25709. doi:3402/gha.v8.25709
  10. National Surgical Obstetric Anesthesia Planning (NSOAP) Manual. UNITAR. https://unitar.org/sustainable-development-goals/people/our-portfolio/programme-health-and-development/global-surgery/national-surgical-obstetric-anesthesia-planning-nsoap-manual.
  11. Fatima I, Shoman H, Peters AW, Samad L, Nishtar S. Pakistan’s National Surgical, Obstetric, and Anesthesia Plan: an adapted model for a devolved federal-provincial health system. Can J Anaesth. 2020;67(9):1212-1216. doi:1007/s12630-020-01708-2
  12. Citron I, Jumbam D, Dahm J, et al. Towards equitable surgical systems: development and outcomes of a national surgical, obstetric and anaesthesia plan in Tanzania. BMJ Glob Health. 2019;4(2):e001282. doi:1136/bmjgh-2018-001282
  13. Ministry of Health of Rwanda. National Surgical, Obstetrics, and Anesthesia Plan 2018-2024. https://www.moh.gov.rw/fileadmin/user_upload/Moh/Publications/Strategic_Plan/NSOAP_Rwanda-_Approved1.pdf.
  14. Federal Ministry of Health of Ethiopia. National Safe Surgery Strategic Plan. https://www.pgssc.org/_files/ugd/d9a674_229834ef81bd47ee9cd72f94be1739fe.pdf.
  15. World Bank. Spending for Health in Malawi: Current Trends and Strategies to Improve Efficiency and Equity in Health Financing. Washington, DC: World Bank; 2021. https://openknowledge.worldbank.org/handle/10986/35864.
  16. Robertson FC, Esene IN, Kolias AG, et al. Global perspectives on task shifting and task sharing in neurosurgery. World Neurosurg X. 2020; 6:100060. doi:1016/j.wnsx.2019.100060
  17. Federspiel F, Mukhopadhyay S, Milsom P, Scott JW, Riesel JN, Meara JG. Global surgical and anaesthetic task shifting: a systematic literature review and survey. Lancet. 2015;385 Suppl 2:S46. doi:1016/s0140-6736(15)60841-8
  18. Landes M, Thompson C, Mwinjiwa E, et al. Task shifting of triage to peer expert informal care providers at a tertiary referral HIV clinic in Malawi: a cross-sectional operational evaluation. BMC Health Serv Res. 2017; 17(1):341. doi:1186/s12913-017-2291-3
  19. Callaghan M, Ford N, Schneider H. A systematic review of task-shifting for HIV treatment and care in Africa. Hum Resour Health. 2010;8:8. doi:1186/1478-4491-8-8

Articles in Press, Corrected Proof
Available Online from 29 March 2022
  • Receive Date: 02 December 2021
  • Revise Date: 20 March 2022
  • Accept Date: 28 March 2022
  • First Publish Date: 29 March 2022