Exploring the Relationship Between Surgical Capacity and Output in Ghana: Current Capacity Assessments May Not Tell the Whole Story

Abstract

Objective: Capacity assessments serve as surrogates for surgical output in low- and middle-income countries where detailed registers do not exist. The relationship between surgical capacity and output was evaluated in Ghana to determine whether a more critical interpretation of capacity assessment data is needed on which to base health systems strengthening initiatives.

Methods: A standardized surgical capacity assessment was performed at 37 hospitals nationwide using WHO guidelines; availability of 25 essential resources and capabilities was used to create a composite capacity score that ranged from 0 (no availability of essential resources) to 75 (constant availability) for each hospital. Data regarding the number of essential operations performed over 1 year, surgical specialties available, hospital beds, and functional operating rooms were also collected. The relationship between capacity and output was explored.

Results: The median surgical capacity score was 37 [interquartile range (IQR) 29-48; range 20-56]. The median number of essential operations per year was 1480 (IQR 736-1932) at first-level hospitals; 1545 operations (IQR 984-2452) at referral hospitals; and 11,757 operations (IQR 3769-21,256) at tertiary hospitals. Surgical capacity and output were not correlated (p > 0.05).

Conclusions: Contrary to current understanding, surgical capacity assessments may not accurately reflect surgical output. To improve the validity of surgical capacity assessments and facilitate maximal use of available resources, other factors that influence output should also be considered, including demand-side factors; supply-side factors and process elements; and health administration and management factors.

Fig. 1

Relationship between surgical care capacity and essential surgical output at hospitals in Ghana. Capacity score—a composite score of 25 essential surgical care resources as outlined by the World Health Organization and The World Bank, the score ranges from 0 (no essential resource availability) to 75 (full and constant essential resource availability); surgical specialty coverage—in-hospital or on-call availability of general surgery-, obstetrics and gynecology-, orthopedics-, and/or urology-trained surgeon(s); operations performed per year—number of essential operations as defined by The World Bank Disease Control Priorities Project 3rd Edition performed from May 31 to June 1, 2014–2015, respectively; seven hospitals that had either a capacity score or output outlier with significant leverage and/or inuence on the model were excluded