Human Resource and Funding Constraints for Essential Surgery in District Hospitals in Africa: A Retrospective Cross-Sectional Survey
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{"title"=>"Human resource and funding constraints for essential surgery in district hospitals in africa: A retrospective cross-sectional survey", "type"=>"journal", "authors"=>[{"first_name"=>"Margaret E.", "last_name"=>"Kruk", "scopus_author_id"=>"15839907000"}, {"first_name"=>"Andreas", "last_name"=>"Wladis", "scopus_author_id"=>"56048409900"}, {"first_name"=>"Naboth", "last_name"=>"Mbembati", "scopus_author_id"=>"6602360712"}, {"first_name"=>"S. Khady", "last_name"=>"Ndao-Brumblay", "scopus_author_id"=>"6506742037"}, {"first_name"=>"Renee Y.", "last_name"=>"Hsia", "scopus_author_id"=>"7004752697"}, {"first_name"=>"Moses", "last_name"=>"Galukande", "scopus_author_id"=>"23567592900"}, {"first_name"=>"Sam", "last_name"=>"Luboga", "scopus_author_id"=>"6506434605"}, {"first_name"=>"Alphonsus", "last_name"=>"Matovu", "scopus_author_id"=>"36004859400"}, {"first_name"=>"Helder", "last_name"=>"de Miranda", "scopus_author_id"=>"35387837500"}, {"first_name"=>"Doruk", "last_name"=>"Ozgediz", "scopus_author_id"=>"56972130100"}, {"first_name"=>"Ana Romàn", "last_name"=>"Quiñones", "scopus_author_id"=>"25031756900"}, {"first_name"=>"Peter C.", "last_name"=>"Rockers", "scopus_author_id"=>"24830976900"}, {"first_name"=>"Johan", "last_name"=>"von Schreeb", "scopus_author_id"=>"6507104780"}, {"first_name"=>"Fernando", "last_name"=>"Vaz", "scopus_author_id"=>"21741603500"}, {"first_name"=>"Haile T.", "last_name"=>"Debas", "scopus_author_id"=>"7006704789"}, {"first_name"=>"Sarah B.", "last_name"=>"Macfarlane", "scopus_author_id"=>"55675584900"}], "year"=>2010, "source"=>"PLoS Medicine", "identifiers"=>{"sgr"=>"77950683574", "doi"=>"10.1371/journal.pmed.1000242", "pui"=>"358607694", "pmid"=>"20231869", "scopus"=>"2-s2.0-77950683574", "issn"=>"15491277", "isbn"=>"1549-1277"}, "id"=>"88b0525c-45b5-32a1-a9a0-719b927f19f5", "abstract"=>"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.\\n\\nMETHODS AND FINDINGS: We conducted a retrospective cross-sectional survey of data from eight district hospitals in Mozambique, Tanzania, and Uganda. There were no specialist surgeons or anesthetists in any of the hospitals. 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%). There were one to six medical doctors per hospital (4.2% of clinical staff). Most major surgical procedures were performed by doctors (54.6%), however over one-third (35.9%) were done by MLPs. Anesthesia was mainly provided by nurses (39.4%). Most of the hospital expenditure was related to staffing. 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.\\n\\nCONCLUSION: African countries have adopted different policies to ensure the provision of surgical care in their respective district hospitals. Overall, the surgical output per capita was very low, reflecting low staffing ratios and limited expenditures for surgery. We found that most surgical and anesthesia services in the three countries in the study were provided by generalist doctors, MLPs, and nurses. Although more information is needed to estimate unmet need for surgery, increasing the funds allocated to surgery, and, in the absence of trained doctors and surgeons, formalizing the training of MLPs appears to be a pragmatic and cost-effective way to make basic surgical services available in underserved areas. Please see later in the article for the Editors' Summary.", "link"=>"http://www.mendeley.com/research/human-resource-funding-constraints-essential-surgery-district-hospitals-africa-retrospective-crossse", "reader_count"=>98, "reader_count_by_academic_status"=>{"Unspecified"=>2, "Professor > Associate Professor"=>7, "Librarian"=>2, "Researcher"=>15, "Student > Doctoral Student"=>10, "Student > Ph. D. Student"=>7, "Student > Postgraduate"=>9, "Student > Master"=>17, "Other"=>11, "Student > Bachelor"=>11, "Lecturer"=>1, "Lecturer > Senior Lecturer"=>2, "Professor"=>4}, "reader_count_by_user_role"=>{"Unspecified"=>2, "Professor > Associate Professor"=>7, "Librarian"=>2, "Researcher"=>15, "Student > Doctoral Student"=>10, "Student > Ph. D. Student"=>7, "Student > Postgraduate"=>9, "Student > Master"=>17, "Other"=>11, "Student > Bachelor"=>11, "Lecturer"=>1, "Lecturer > Senior Lecturer"=>2, "Professor"=>4}, "reader_count_by_subject_area"=>{"Unspecified"=>9, "Engineering"=>1, "Nursing and Health Professions"=>3, "Medicine and Dentistry"=>58, "Agricultural and Biological Sciences"=>6, "Arts and Humanities"=>1, "Business, Management and Accounting"=>3, "Physics and Astronomy"=>1, "Social Sciences"=>13, "Economics, Econometrics and Finance"=>2, "Linguistics"=>1}, "reader_count_by_subdiscipline"=>{"Engineering"=>{"Engineering"=>1}, "Medicine and Dentistry"=>{"Medicine and Dentistry"=>58}, "Social Sciences"=>{"Social Sciences"=>13}, "Physics and Astronomy"=>{"Physics and Astronomy"=>1}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>2}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>6}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>3}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>3}, "Linguistics"=>{"Linguistics"=>1}, "Unspecified"=>{"Unspecified"=>9}, "Arts and Humanities"=>{"Arts and Humanities"=>1}}, "reader_count_by_country"=>{"Canada"=>2, "United States"=>4, "Norway"=>2, "United Kingdom"=>1}, "group_count"=>6}

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  • {"files"=>["https://ndownloader.figshare.com/files/860929"], "description"=>"a<p>Ugandan hospitals are referred to as “General Hospitals” rather than “District Hospitals.” The “Other” hospital in Mubende district is another “General” hospital.</p>b<p><a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000242#pmed.1000242-US1\" target=\"_blank\">[41]</a>.</p>c<p>2002 country-level census data.</p>d<p>2007 country-level census data.</p>", "links"=>[], "tags"=>["facilities"], "article_id"=>531366, "categories"=>["Medicine"], "users"=>["Margaret E. Kruk", "Andreas Wladis", "Naboth Mbembati", "S. Khady Ndao-Brumblay", "Renee Y. Hsia", "Moses Galukande", "Sam Luboga", "Alphonsus Matovu", "Helder de Miranda", "Doruk Ozgediz", "Ana Romàn Quiñones", "Peter C. Rockers", "Johan von Schreeb", "Fernando Vaz", "Haile T. Debas", "Sarah B. Macfarlane"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000242.t002", "stats"=>{"downloads"=>0, "page_views"=>3, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Distribution_of_health_care_facilities_by_study_site_and_population_served_/531366", "title"=>"Distribution of health care facilities by study site and population served.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-21 02:28:06"}
  • {"files"=>["https://ndownloader.figshare.com/files/861083"], "description"=>"a<p>The numerator is overall annual hospital expenditures.</p>b<p>The numerator is overall inpatient surgical expenditures.</p>c<p>For each percentage, the numerator is the expenditures for each inpatient service, and the denominator is the overall annual operating expenditures.</p>d<p>Cost allocation is done under the conservative assumption that 50% of personnel cost and 70% of non-personnel costs are attributable to inpatient care.</p><p>MZ, Mozambique; TZ,Tanzania; UG, Uganda.</p>", "links"=>[], "tags"=>["recurrent", "expenditures", "inpatient"], "article_id"=>531527, "categories"=>["Medicine"], "users"=>["Margaret E. Kruk", "Andreas Wladis", "Naboth Mbembati", "S. Khady Ndao-Brumblay", "Renee Y. Hsia", "Moses Galukande", "Sam Luboga", "Alphonsus Matovu", "Helder de Miranda", "Doruk Ozgediz", "Ana Romàn Quiñones", "Peter C. Rockers", "Johan von Schreeb", "Fernando Vaz", "Haile T. Debas", "Sarah B. Macfarlane"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000242.t007", "stats"=>{"downloads"=>1, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_District_hospital_average_recurrent_expenditures_by_volume_and_type_of_inpatient_service_/531527", "title"=>"District hospital average recurrent expenditures by volume and type of inpatient service.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-21 02:28:56"}
  • {"files"=>["https://ndownloader.figshare.com/files/860872"], "description"=>"<p>Training and clinical scope of practice of MLPs in Tanzania, Mozambique, and Uganda.</p>", "links"=>[], "tags"=>["mlps"], "article_id"=>531313, "categories"=>["Medicine"], "users"=>["Margaret E. Kruk", "Andreas Wladis", "Naboth Mbembati", "S. Khady Ndao-Brumblay", "Renee Y. Hsia", "Moses Galukande", "Sam Luboga", "Alphonsus Matovu", "Helder de Miranda", "Doruk Ozgediz", "Ana Romàn Quiñones", "Peter C. Rockers", "Johan von Schreeb", "Fernando Vaz", "Haile T. Debas", "Sarah B. Macfarlane"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000242.t003", "stats"=>{"downloads"=>0, "page_views"=>17, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Training_and_clinical_scope_of_practice_of_MLPs_in_Tanzania_Mozambique_and_Uganda_/531313", "title"=>"Training and clinical scope of practice of MLPs in Tanzania, Mozambique, and Uganda.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-21 02:27:50"}
  • {"files"=>["https://ndownloader.figshare.com/files/860977"], "description"=>"a<p>Surgical procedures are for February, June, and October 2007.</p>b<p>Surgical procedures are underrepresented in October for Mozambique, where medical staff undergoes training during that month: there were no procedures for Catandica compared to a monthly average of 20 procedures, and 16 in Chokwe compared to 50 monthly average.</p>c<p>Surgical procedures are for February, June, and October 2006.</p>d<p>137 unspecified surgeries were performed by doctors, three by assistant medical officers, 16 by nurses/others, and three providers were not identified.</p><p>MZ, Mozambique; OB, obstetric; TZ,Tanzania; UG, Uganda.</p>", "links"=>[], "tags"=>["procedures", "performed", "months"], "article_id"=>531413, "categories"=>["Medicine"], "users"=>["Margaret E. Kruk", "Andreas Wladis", "Naboth Mbembati", "S. Khady Ndao-Brumblay", "Renee Y. Hsia", "Moses Galukande", "Sam Luboga", "Alphonsus Matovu", "Helder de Miranda", "Doruk Ozgediz", "Ana Romàn Quiñones", "Peter C. Rockers", "Johan von Schreeb", "Fernando Vaz", "Haile T. Debas", "Sarah B. Macfarlane"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000242.t005", "stats"=>{"downloads"=>1, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Surgical_procedures_performed_by_type_of_medical_provider_for_three_selected_months_February_June_and_October_/531413", "title"=>"Surgical procedures performed by type of medical provider for three selected months (February, June, and October).", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-21 02:28:23"}
  • {"files"=>["https://ndownloader.figshare.com/files/861042"], "description"=>"a<p>The classification of nurses in Catandica may not fully correspond to the study classification; of the 18 nurses two were general nurses with mid-level training, two were maternity and child health nurses with mid-level training, three were nurses with elementary level training, and 11 were nurses with basic level nurses. Nurses with mid-level training were classified as nurse assistants, nurses with elementary training and nurses with basic level skills were classified as enrolled nurses, and maternal and child health nurses were classified as nurse midwives.</p>b<p>In Mozambique, assistant medical officers performing surgery are referred to as “técnicos de cirurgia.”</p>c<p>Nurse assistants in Bagamoyo are referred to as medical attendants.</p><p>MZ, Mozambique; TZ, Tanzania; UG, Uganda.</p>", "links"=>[], "tags"=>["resources"], "article_id"=>531478, "categories"=>["Medicine"], "users"=>["Margaret E. Kruk", "Andreas Wladis", "Naboth Mbembati", "S. Khady Ndao-Brumblay", "Renee Y. Hsia", "Moses Galukande", "Sam Luboga", "Alphonsus Matovu", "Helder de Miranda", "Doruk Ozgediz", "Ana Romàn Quiñones", "Peter C. Rockers", "Johan von Schreeb", "Fernando Vaz", "Haile T. Debas", "Sarah B. Macfarlane"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000242.t004", "stats"=>{"downloads"=>0, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Human_resources_distribution_in_study_hospitals_/531478", "title"=>"Human resources distribution in study hospitals.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-21 02:28:40"}
  • {"files"=>["https://ndownloader.figshare.com/files/860822"], "description"=>"<p><a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000242#pmed.1000242-Mullan1\" target=\"_blank\">[16]</a>. N/A, not applicable.</p>", "links"=>[], "tags"=>["doing"], "article_id"=>531259, "categories"=>["Medicine"], "users"=>["Margaret E. Kruk", "Andreas Wladis", "Naboth Mbembati", "S. Khady Ndao-Brumblay", "Renee Y. Hsia", "Moses Galukande", "Sam Luboga", "Alphonsus Matovu", "Helder de Miranda", "Doruk Ozgediz", "Ana Romàn Quiñones", "Peter C. Rockers", "Johan von Schreeb", "Fernando Vaz", "Haile T. Debas", "Sarah B. Macfarlane"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000242.t001", "stats"=>{"downloads"=>1, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_MLPs_doing_surgery_anesthesia_in_SSA_/531259", "title"=>"MLPs doing surgery/anesthesia in SSA.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-21 02:27:34"}
  • {"files"=>["https://ndownloader.figshare.com/files/860738"], "description"=>"<p>(A) Major surgeries; (B) minor surgeries; (C) anesthesia for major surgeries. Note: MLPs highlighted.</p>", "links"=>[], "tags"=>["anesthesia", "hospitals", "sub-saharan", "african"], "article_id"=>531165, "categories"=>["Medicine"], "users"=>["Margaret E. Kruk", "Andreas Wladis", "Naboth Mbembati", "S. Khady Ndao-Brumblay", "Renee Y. Hsia", "Moses Galukande", "Sam Luboga", "Alphonsus Matovu", "Helder de Miranda", "Doruk Ozgediz", "Ana Romàn Quiñones", "Peter C. Rockers", "Johan von Schreeb", "Fernando Vaz", "Haile T. Debas", "Sarah B. Macfarlane"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000242.g001", "stats"=>{"downloads"=>2, "page_views"=>17, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Providers_of_major_surgery_minor_surgery_and_anesthesia_across_eight_hospitals_in_three_Sub_Saharan_African_countries_/531165", "title"=>"Providers of major surgery, minor surgery, and anesthesia across eight hospitals in three Sub-Saharan African countries.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-02-21 02:27:04"}
  • {"files"=>["https://ndownloader.figshare.com/files/861150"], "description"=>"a<p>Surgical procedures are for February, June, and October 2007.</p>b<p>Surgical procedures are under-represented in October for Mozambique, where medical staff undergoes training during that month: there were no procedures for Catandica compared to a monthly average of 20 procedures, and 16 in Chokwe compared to 50 monthly average.</p>c<p>Surgical procedures are for February, June, and October 2006.</p><p>MZ, Mozambique; OB, obstetric; TZ, Tanzania; UG, Uganda.</p>", "links"=>[], "tags"=>["months"], "article_id"=>531582, "categories"=>["Medicine"], "users"=>["Margaret E. Kruk", "Andreas Wladis", "Naboth Mbembati", "S. Khady Ndao-Brumblay", "Renee Y. Hsia", "Moses Galukande", "Sam Luboga", "Alphonsus Matovu", "Helder de Miranda", "Doruk Ozgediz", "Ana Romàn Quiñones", "Peter C. Rockers", "Johan von Schreeb", "Fernando Vaz", "Haile T. Debas", "Sarah B. Macfarlane"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1000242.t006", "stats"=>{"downloads"=>1, "page_views"=>10, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Anesthesia_provided_by_type_of_medical_provider_for_three_selected_months_February_June_and_October_/531582", "title"=>"Anesthesia provided by type of medical provider for three selected months (February, June, and October).", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-21 02:29:14"}

PMC Usage Stats | Further Information

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