Surgical safety
The challenges of surgical provision in Africa
Kate Woodhead high- lights the surgical safety challenges experienced in African regions and shares her insights from a recent visit to Rwanda by Friends of African Nursing.
A multitude of different factors affect the access for patients to get a surgical service in the vast territory of Sub-Saharan Africa and the many different countries. These include insufficient healthcare workers, poor infrastructure, lack of suitable equipment and supplies, and poverty among the population needing surgery. A study reporting on the people and facilities for Uganda identified that there was a total of 107 general surgeons, 97 specialty surgeons, 124 obstetricians/gynaecologists (OB/ GYNs), and 17 anaesthesiologists in Uganda, for a rate of one surgeon per 100,000 people. There was 0.2 major operating theatres per 100,000 people. Altogether, 53% of all operations were general
surgery cases, and 44% were OB/GYN cases. In all, 73% of all operations were performed on an emergency basis. All hospitals reported unreliable supplies of water and electricity. Essential equipment was missing across all hospitals, with no pulse oximeters found at any facilities.1
In 2005, slightly over one quarter of a
million women in Africa died from complications of childbirth: most of these deaths could have been avoided by providing women with access to basic obstetric and obstetric surgical care.2 How does the situation described affect
potential patients? We understand that there is an increasing need for surgery due to more trauma, a greater reliance on Caesarean section deliveries, people living longer and therefore more likely to suffer the diseases of older age, and a greater prevalence of cancer, which needs surgical intervention. Surgical disease is thought to account for a substantial proportion of the global burden of disease; some estimates have suggested 11% of the global need for healthcare.3 The World Bank cited five million people died
Healthcare workers There is a tremendous shortage of health workers throughout sub-Saharan Africa and among them there are not enough healthcare workers trained to provide surgical services. There is a chronic and critical shortfall in the numbers of healthcare staff, which has daunting implications for maternal and infant mortality, infectious diseases, non-communicable diseases,5
let alone an expansion of surgery.
A recent study showed that the total stock of health workers was approximately 3.6 million across 47 countries. Among these, 37% of the health workers
were nurses and midwives, 9% were medical doctors, 10% were laboratory personnel, 14% were community health workers, 14% were other
of injuries in 2012 and around 5 billion people lack access to surgical services. There is a great need for surgical facilities to be scaled up, therefore, in District hospitals that ought to be able to cope with a greater range of procedures than currently. If this were to happen, this might prevent 6-7% of all preventable deaths in low and middle income countries (LMICs).4
health workers, and 12% were administrative and support staff. Results show uneven distribution of health workers within the African Region. Most health workers (85%) are in the public sector. Regional density of physicians, nurses and midwives per 1000 population was 1.55, only 4 countries had densities of more than 4.45 physicians, nurses and midwives per 1000 population, which is the WHO recommended minimum. It is estimated that by 2030, there will be a shortfall of 6.1 million healthcare workers in Africa.6 Low staffing levels are borne out by a recent
visit to Rwanda by Friends of African Nursing, as we delivered perioperative education to nurses. We taught in Main Operating Theatres which have 48 WTE as a complete establishment; in the UK, we might expect around 200 WTE for the same number of operating theatres. Our experience applies largely to nursing staff but can also be found in specialist surgeons, nurses and anaesthetists. Time out for education is definitely lacking. In one small country where we have taught, nurses are allocated to perioperative care and moved around the country at will, according to the needs of the
September 2024 I
www.clinicalservicesjournal.com 15
t
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80
