'We are all serving the same Ugandans': A nationwide mixed-methods evaluation of private sector surgical capacity in Uganda.
Anesthesiology
Blood Banks
Cesarean Section
/ statistics & numerical data
Delivery of Health Care
Equipment and Supplies, Hospital
/ supply & distribution
Female
Health Resources
/ supply & distribution
Health Services Accessibility
/ economics
Humans
Laparotomy
/ statistics & numerical data
Organizations, Nonprofit
Pregnancy
Private Sector
/ statistics & numerical data
Retrospective Studies
Surgeons
/ supply & distribution
Surgical Procedures, Operative
/ statistics & numerical data
Uganda
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2019
2019
Historique:
received:
15
07
2019
accepted:
08
10
2019
entrez:
25
10
2019
pubmed:
28
10
2019
medline:
21
3
2020
Statut:
epublish
Résumé
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. 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. 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. 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.
Identifiants
pubmed: 31648234
doi: 10.1371/journal.pone.0224215
pii: PONE-D-19-19864
pmc: PMC6812829
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0224215Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Int J Gynaecol Obstet. 2016 Nov;135 Suppl 1:S2-S6
pubmed: 27836079
Afr Health Sci. 2017 Jun;17(2):481-490
pubmed: 29062344
Bull World Health Organ. 2011 Aug 1;89(8):565-72
pubmed: 21836755
Injury. 2016 Sep;47(9):1990-5
pubmed: 27178767
Lancet. 2008 Feb 23;371(9613):627-628
pubmed: 18295007
World Neurosurg. 2017 Dec;108:844-849.e4
pubmed: 28826868
Trop Med Int Health. 2010 Sep;15(9):1109-15
pubmed: 20636302
World J Surg. 2018 Jul;42(7):1971-1980
pubmed: 29270649
S Afr Med J. 2017 Nov 27;107(12):1099-1105
pubmed: 29262964
Health Econ. 2003 Nov;12(11):921-34
pubmed: 14601155
World J Surg. 2018 Aug;42(8):2303-2313
pubmed: 29368021
World J Surg. 2015 Jul;39(7):1700-7
pubmed: 25665677
World J Surg. 2017 Feb;41(2):353-363
pubmed: 27539489
BMJ Glob Health. 2016 Dec 16;1(4):e000075
pubmed: 28588976
Br J Surg. 2012 Mar;99(3):436-43
pubmed: 22237597
Health Policy Plan. 2015 Oct;30(8):985-94
pubmed: 25261799
Arch Surg. 2009 Feb;144(2):122-7; discussion 128
pubmed: 19221322
J Am Coll Surg. 2011 Jan;212(1):20-28.e1
pubmed: 21184955
Int J Surg. 2014;12(9):906-11
pubmed: 25084098
PLoS One. 2018 Apr 17;13(4):e0195986
pubmed: 29664956
World J Surg. 2013 Apr;37(4):721-9
pubmed: 23404484
World J Surg. 2017 Mar;41(3):660-671
pubmed: 27778076
World J Surg. 2012 Dec;36(12):2811-8
pubmed: 22955951
Anesth Analg. 2016 May;122(5):1634-9
pubmed: 26983052
BMC Health Serv Res. 2017 Sep 25;17(1):676
pubmed: 28946885
World J Surg. 2017 May;41(5):1218-1224
pubmed: 27905017
Lancet. 2015 May 30;385(9983):2209-19
pubmed: 25662414
BMC Health Serv Res. 2013 Apr 16;13:140
pubmed: 23590288
World J Surg. 2012 Aug;36(8):1970-7
pubmed: 22488329
Surgery. 2015 Jun;157(6):992-1001
pubmed: 25934081
Ann Surg. 2017 Aug;266(2):389-399
pubmed: 27611619
BMC Pregnancy Childbirth. 2017 Nov 17;17(1):387
pubmed: 29149877
World J Surg. 2012 May;36(5):1056-65
pubmed: 22402968
Lancet Glob Health. 2015 Apr 27;3 Suppl 2:S9-11
pubmed: 25926323
Int J Gynaecol Obstet. 2016 Nov;135 Suppl 1:S7-S10
pubmed: 27836088
World J Surg. 2015 Mar;39(3):669-76
pubmed: 25491193
Lancet. 2015 Aug 8;386(9993):569-624
pubmed: 25924834
Glob Public Health. 2013;8(4):417-34
pubmed: 23590804
PLoS One. 2016 Feb 24;11(2):e0150080
pubmed: 26910462
BMJ Open. 2014 May 07;4(5):e004360
pubmed: 24812189
Lancet Glob Health. 2015 Apr 27;3 Suppl 2:S38-44
pubmed: 25926319
World J Surg. 2013 Sep;37(9):2109-21
pubmed: 23756772
J Pediatr Surg. 2013 Jun;48(6):1363-70
pubmed: 23845631
World J Surg. 2012 Nov;36(11):2554-8
pubmed: 22851151
World J Surg. 2011 Aug;35(8):1770-80
pubmed: 21562869
Surgery. 2017 Jun;161(6):1710-1719
pubmed: 28259351
Health Aff (Millwood). 2007 Jul-Aug;26(4):972-83
pubmed: 17630440
BMC Health Serv Res. 2015 Oct 23;15:478
pubmed: 26496762