| dc.description.abstract | There is a growing recognition that the provision of surgical services in low-income countries is inadequate to
the need. While constrained health budgets and health worker shortages have been blamed for the low rates of surgery,
there has been little empirical data on the providers of surgery and cost of surgical services in Africa. This study described
the range of providers of surgical care and anesthesia and estimated the resources dedicated to surgery at district hospitals
in three African countries.
Methods and Findings: We conducted a retrospective cross-sectional survey of data from eight district hospitals in
Mozambique, Tanzania, and Uganda. There were no specialist surgeons or anesthetists in any of the hospitals. Most of the
health workers were nurses (77.5%), followed by mid-level providers (MLPs) not trained to provide surgical care (7.8%), and
MLPs trained to perform surgical procedures (3.8%). There were one to six medical doctors per hospital (4.2% of clinical
staff). Most major surgical procedures were performed by doctors (54.6%), however over one-third (35.9%) were done by
MLPs. Anesthesia was mainly provided by nurses (39.4%). Most of the hospital expenditure was related to staffing. Of the
total operating costs, only 7% to 14% was allocated to surgical care, the majority of which was for obstetric surgery. These
costs represent a per capita expenditure on surgery ranging from US$0.05 to US$0.14 between the eight hospitals.
Conclusion: African countries have adopted different policies to ensure the provision of surgical care in their respective
district hospitals. Overall, the surgical output per capita was very low, reflecting low staffing ratios and limited expenditures
for surgery. We found that most surgical and anesthesia services in the three countries in the study were provided by
generalist doctors, MLPs, and nurses. Although more information is needed to estimate unmet need for surgery, increasing
the funds allocated to surgery, and, in the absence of trained doctors and surgeons, formalizing the training of MLPs
appears to be a pragmatic and cost-effective way to make basic surgical services available in underserved areas. | en_US |
