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. 2017 Mar 6;7(3):e014496.
doi: 10.1136/bmjopen-2016-014496.

Retrospective review of Surgical Availability and Readiness in 8 African countries

D A Spiegel  1 , B Droti  2 , P Relan  3 , S Hobson  4 , M N Cherian  2 , K O'Neill  2
Affiliations

Retrospective review of Surgical Availability and Readiness in 8 African countries

D A Spiegel et al. BMJ Open. .

Abstract

Objectives: The purpose of this study was to assess surgical availability and readiness in 8 African countries using the WHO's Service Availability and Readiness Assessment (SARA) tool.

Setting: We analysed data for surgical services, including basic and comprehensive surgery, comprehensive obstetric care, blood transfusion, and infection prevention, obtained from the WHO's SARA surveys in Sierra Leone, Uganda, Mauritania, Benin, Zambia, Burkina Faso, Democratic Republic of Congo and Togo.

Primary and secondary outcome measures: Among the facilities that were expected to offer surgical services (N=3492), there were wide disparities between the countries in the number of facilities per 100 000 population that reported offering basic surgery (1.0-12.1), comprehensive surgery (0.1-0.8), comprehensive obstetric care (0.1-0.8) and blood transfusion (0.1-0.8). Only 0.1-0.3 facilities per 100 000 population had all three bellwether procedures available, namely laparotomy, open fracture management and caesarean section. In all the countries, the facilities that reported offering surgical services generally had a shortage of the necessary items for offering the services and this varied greatly between the countries, with the facilities having on average 27-53% of the items necessary for offering basic surgery, 56-83% for comprehensive surgery, 49-72% for comprehensive obstetric care and 54-80% for blood transfusion. Furthermore, few facilities had all the necessary items present. However, facilities that reported offering surgical services had on average most of the necessary items for the prevention of infection.

Conclusions: There are important gaps in the surgical services in the 8 African countries surveyed. Efforts are therefore urgently needed to address deficiencies in the availability and readiness to deliver surgical services in these nations, and this will require commitment from multiple stakeholders. SARA may be used to monitor availability and readiness at regular intervals, which will enable stakeholders to evaluate progress and identify gaps and areas for improvement.

Keywords: Africa; Deficiencies; SARA; Surgical services.

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Conflict of interest statement

Competing interests: The authors include WHO staff, and the views expressed in this publication reflect their views and not necessarily that of WHO. One of the authors (DAS) has served as a consultant for the WHO.

Figures

Figure 1
Figure 1
Number of facilities that reported offering basic surgical services per 100 000 people.
Figure 2
Figure 2
Number of facilities that reported offering comprehensive surgery per 100 000 people.
Figure 3
Figure 3
Number of facilities that reported offering comprehensive obstetric care per 100 000 people.
Figure 4
Figure 4
Number of facilities that reported offering signal emergency services (Bellwether procedures) per 100 000 people.
Figure 5
Figure 5
Mean (%) of items for basic surgery and percentage facilities with all the items.
Figure 6
Figure 6
Mean (%) of items for comprehensive surgery and percentage facilities with all the items.
Figure 7
Figure 7
Mean (%) of items for comprehensive obstetric care and percentage facilities with all the items.
Figure 8
Figure 8
Mean (%) of tracer items for blood transfusion and percentage facilities with all the items.
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