‘We are all serving the same Ugandans’: A nationwide mixed-methods evaluation of private sector surgical capacity in Uganda


Autoři: Katherine Albutt aff001;  Gustaf Drevin aff002;  Rachel R. Yorlets aff002;  Emma Svensson aff002;  Didacus B. Namanya aff006;  Mark G. Shrime aff002;  Peter Kayima aff009
Působiště autorů: Department of Surgery, Massachusetts General Hospital (MGH), Boston, MA, United States of America aff001;  Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, Boston, MA, United States of America aff002;  Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden aff003;  Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, MA, United States of America aff004;  Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden aff005;  Ministry of Health (MOH), Kampala, Uganda aff006;  Uganda Martyrs University (UMU), Nkozi, Uganda aff007;  Center for Global Surgery Evaluation, Massachusetts Eye and Ear Infirmary, Boston, MA, United States of America aff008;  Mbarara University of Science and Technology (MUST), Mbarara, Uganda aff009;  St. Mary's Lacor Hospital, Gulu, Uganda aff010
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224215

Souhrn

Introduction

Half of all Ugandans (49%) turn to the private or private-not-for-profit (PNFP) sectors when faced with illness, yet little is known about the capacity of these sectors to deliver surgical services. We partnered with the Ministry of Health to conduct a nationwide mixed-methods evaluation of private and PNFP surgical capacity in Uganda.

Methods

A standardized validated facility assessment tool was utilized to assess facility infrastructure, service delivery, workforce, information management, and financing at a randomized nationally representative sample of 16 private and PNFP hospitals. Semi-structured interviews were conducted to qualitatively explore facilitating factors and barriers to surgical, obstetric and anaesthesia (SOA) care. Hospitals walk-throughs and retrospective reviews of operative logbooks were completed.

Results

Hospitals had a median of 177 beds and two operating rooms. Ten hospitals (62.5%) were able to perform all Bellwether procedures (cesarean section, laparotomy and open fracture treatment). Thirty-day surgical volume averaged 102 cases per facility. While most hospitals had electricity, oxygen, running water, and necessary equipment, many reported pervasive shortages of blood, surgical consumables, and anesthetic drugs. Several themes emerged from the qualitative analysis: (1) geographic distance and limited transportation options delay reaching care; (2) workforce shortages impede the delivery of surgical care; (3) emergency and obstetric volume overwhelm the surgical system; (4) medical and non-medical costs delay seeking, reaching, and receiving care; and (5) there is poor coordination of care with insufficient support systems.

Conclusion

As in Uganda’s public sector, barriers to surgery in private and PNFP hospitals in Uganda are cross-cutting and closely tied to resource availability. Critical policy and programmatic developments are essential to build and strengthen Ugandan surgical capacity across all sectors.

Klíčová slova:

Critical care and emergency medicine – Finance – Labor and delivery – Obstetric procedures – Obstetrics and gynecology – Surgical and invasive medical procedures – Trauma surgery – Uganda


Zdroje

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