Exploring the Relationship Between Surgical Capacity and Output in Ghana: Current Capacity Assessments May Not Tell the Whole Story
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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.
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.
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).
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.
This study was funded, in part, by grants from: the University of Washington Department of Surgery Research Reinvestment Fund; and grants (R25-TW009345; D43-TW007267) from the Fogarty International Center, US National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors thank Victor Oppong-Nketia and Adofo Koranteng for their assistance with hospital visits. In addition, we thank the Ghana Ministry of Health, Regional Health Directorates, and hospital staff for facilitating site visits.
Compliance with Ethical Standards
Conflict of interest
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
- 2.Stewart BT, Quansah R, Gyedu A, Boakye G, Abantanga F, Ankomah J et al (2015) Serial assessment of trauma care capacity in Ghana in 2004 and 2014. JAMA Surg 2015:1–8Google Scholar
- 4.Price RI, Makasa E, Hollands M (2015) Strengthening emergency and essential surgical care and anesthesia as a component of universal health coverage—addressing the public health gaps arising from lack of safe, affordable and accessible surgical and anesthetic services. World J Surg 39(9):2115–2125. https://doi.org/10.1007/s00268-015-3153-y CrossRefPubMedGoogle Scholar
- 5.Weiser TG, Regenbogen SE, Thompson KD, Haynes AB, Lipsitz SR, Berry WR et al (2008) An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet 372(139–14):4Google Scholar
- 8.Mock C, Lormand J, Goosen J, Joshipura M, Peden M (2004) Guidelines for essential trauma care. World Health Organization, GenevaGoogle Scholar
- 9.WHO (2013) WHO generic essential emergency equipment list. In: care Eaes editor Integrated Management for Emergency and Essential Surgical Care (IMEESC) toolkit. World Health Organization, GenevaGoogle Scholar
- 10.Osen H, Chang D, Choo S, Perry H, Hesse A, Abantanga F et al (2011) Validation of the World Health Organization tool for situational analysis to assess emergency and essential surgical care at district hospitals in Ghana. World J Surg 35(500–50):4. https://doi.org/10.1007/s00268-010-0918-1 Google Scholar
- 12.World_Bank_Group (2014). http://data.worldbank.org/indicator/NY.GNP.PCAP.CD/countries. 29 July 2014
- 13.Zakariah A, Degbotse D, Osei D, Ofosu A, Nyagblornu N, Bjerrum A (2014) Holistic assessment of the health sector programme of work 2013. Ghana Ministry of Health, AccraGoogle Scholar
- 15.Gyedu A, Baah EG, Boakye G, Ohene-Yeboah M, Otupiri E, Stewart BT (2015) Quality of referrals for elective surgery at a tertiary care hospital in a developing country: an opportunity for improving timely access to and cost-effectiveness of surgical care. Int J Surg 15C(74–7):8Google Scholar
- 16.Stewart BT, Tansley G, Gyedu A, Ofosu A, Donkor P, Appiah-Denkyira E et al (2016) Mapping population-level spatial access to essential surgical care in Ghana using availability of bellwether procedures. JAMA Surg 151(8):e161239. https://doi.org/10.1001/jamasurg.2016.1239 CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Debas HT, Donkor P, Gawande A, Jamison DT, Kruk ME, Mock CN (2015) Essential Surgery. In: Jamison DT, Nugent R, Gelband H et al (eds) disease control priorities, 3rd edn. International Bank for Reconstruction and Development/The World Bank, WashingtonGoogle Scholar
- 22.Shah MT, Bhattarai S, Lamichhane N, Joshi A, LaBarre P, Joshipura M et al (2015) Assessment of the availability of technology for trauma care in Nepal. Injury 46(1712–171):9Google Scholar
- 24.Son NT, Thu NH, Tu NT, Mock C (2007) Assessment of the status of resources for essential trauma care in Hanoi and Khanh Hoa. Vietnam Inj 38:1014–1022Google Scholar
- 28.Shrime MG, Verguet S, Johansson KA, Desalegn D, Jamison DT, Kruk ME (2016) Task-sharing or public finance for the expansion of surgical access in rural Ethiopia: an extended cost-effectiveness analysis. Health Policy Plann 31(706–71):6Google Scholar
- 29.Choo S, Perry H, Hesse AA, Abantanga F, Sory E, Osen H et al (2010) Assessment of capacity for surgery, obstetrics and anaesthesia in 17 Ghanaian hospitals using a WHO assessment tool. Trop Med Int Health TM & IH 15:1109–1115Google Scholar
- 30.Linden A, Mantyniemi S (2011) Using the negative binomial distribution to model overdispersion in ecological count data. Ecology 92(1414–142):1Google Scholar
- 31.Lee AH, Wang K, Yau KK, Somerford PJ (2003) Truncated negative binomial mixed regression modelling of ischaemic stroke hospitalizations. Stat Med 22(1129–113):9Google Scholar
- 32.Baker LC, Schoenman JA, Murphy B, Chockley N (2008) The challenges of health system capacity growth. National Institute for Health Care Management (NIHCM) Foundation, WashingtonGoogle Scholar
- 33.Lindsey JK, Jones B (1998) Choosing among generalized linear models applied to medical data. Stat Med 17(59–6):8Google Scholar
- 34.Pourhoseingholi A, Baghban AA, Zayeri F, Alavian SM, Vahedi M (2013) Statistical count models for prognosis the risk factors of hepatitis C. Gastroenterol Hepatol Bed Bench 6(41–4):7Google Scholar
- 38.Stewart BT, Gyedu A, Quansah R, Addo WL, Afoko A, Agbenorku P et al (2015) District-level hospital trauma care audit filters: Delphi technique for defining context-appropriate indicators for quality improvement initiative evaluation in developing countries. Injury 47:211–219CrossRefPubMedPubMedCentralGoogle Scholar
- 39.Lanktree E, Corluka A, Cohen M, Larocque R (2014) Addressing the human resources for health crisis through task-shifting and retention: results from the Africa Health Systems Initiative Support to African Research Partnerships program. Hum Resour Health 12(Suppl 1):I2CrossRefPubMedPubMedCentralGoogle Scholar
- 40.Bradley EH, Taylor LA, Cuellar CJ (2015) Management matters: a leverage point for health systems strengthening in global health. Int J Health Policy Manag 4(411–41):5Google Scholar
- 41.Murray CJ, Frenk J (2000) A framework for assessing the performance of health systems. Bull World Health Organ 78(717–73):1Google Scholar
- 42.Sen A (1979) The tanner lecture on human values. Stanford University, StanfordGoogle Scholar
- 43.Sen A (1985) Commodities and capabilities. Oxford University Press, Amsterdam & New York, North-HollandGoogle Scholar