Skip to main content
SpringerLink
Log in

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

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Carlson LC, Lin JA, Ameh EA, Mulwafu W, Donkor P, Derbew M et al (2015) Moving from data collection to application: a systematic literature review of surgical capacity assessments and their applications. World J Surg 39(813–82):1. https://doi.org/10.1007/s00268-014-2938-8

    Article  Google Scholar 

  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 2015:1–8

    Google Scholar 

  3. Mock CN, Donkor P, Gawande A, Jamison DT, Kruk ME, Debas HT et al (2015) Essential surgery: key messages from disease control priorities, 3rd edition. Lancet 385:2209–2219

    Article  PubMed  Google 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

    Article  PubMed  Google 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):4

    Google Scholar 

  6. Bolkan HA, Von Schreeb J, Samai MM, Bash-Taqi DA, Kamara TB, Salvesen O et al (2015) Met and unmet needs for surgery in Sierra Leone: a comprehensive, retrospective, countrywide survey from all health care facilities performing operations in 2012. Surgery 157:992–1001

    Article  PubMed  Google Scholar 

  7. http://www.who.int/surgery/publications/s15986e.pdf?ua=1. 31 Dec 2015

  8. Mock C, Lormand J, Goosen J, Joshipura M, Peden M (2004) Guidelines for essential trauma care. World Health Organization, Geneva

    Google 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, Geneva

  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

    Article  Google Scholar 

  11. Markin A, Barbero R, Leow JJ, Groen RS, Skow EJ, Apelgren KN et al (2013) A quantitative analysis of surgical capacity in Santa Cruz, Bolivia. J Surg Res 185:190–197

    Article  PubMed  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, Accra

    Google Scholar 

  14. Stewart BT, Quansah R, Gyedu A, Ankomah J, Donkor P, Mock C (2015) Strategic assessment of trauma care capacity in Ghana. World J Surg 39:2428–2440. https://doi.org/10.1007/s00268-015-3132-3

    Article  PubMed  Google 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):8

    Google 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

    Article  PubMed  PubMed Central  Google Scholar 

  17. Ankomah J, Stewart BT, Oppong-Nketia V, Koranteng A, Gyedu A, Quansah R et al (2015) Strategic assessment of the availability of pediatric trauma care equipment, technology and supplies in Ghana. J Pediatr Surg 50(11):1922–1927

    Article  PubMed  PubMed Central  Google Scholar 

  18. 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:e161239

    Article  PubMed  PubMed Central  Google 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, Washington

    Google Scholar 

  20. Etikan I, Musa S, Alkassim R (2015) Comparison of convenience sampling and purposive samplings. Am J Theor Appl Stat 5:1–4

    Article  Google Scholar 

  21. Mock C, Nguyen S, Quansah R, Arreola-Risa C, Viradia R, Joshipura M (2006) Evaluation of trauma care capabilities in four countries using the WHO-IATSIC guidelines for essential trauma care. World J Surg 30(946–95):6. https://doi.org/10.1007/s00268-005-0768-4

    Article  Google 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):9

    Google Scholar 

  23. Shah MT, Joshipura M, Singleton J, LaBarre P, Desai H, Sharma E et al (2014) Assessment of the availability of technology for trauma care in India. World J Surg 39(363–37):2. https://doi.org/10.1007/s00268-014-2805-7

    Article  Google 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 38:1014–1022

    Google Scholar 

  25. Daniels KM, Riesel JN, Meara JG (2015) The scale-up of the surgical workforce. Lancet 385(Suppl 2):S41

    Article  PubMed  Google Scholar 

  26. Chu KM, Ford NP, Trelles M (2011) Providing surgical care in Somalia: a model of task shifting. Confl Health 5:12

    Article  PubMed  PubMed Central  Google Scholar 

  27. Bolkan HA, van Duinen A, Waalewijn B, Elhassein M, Kamara TB, Deen GF et al (2017) Safety, productivity and predicted contribution of a surgical task-sharing programme in Sierra Leone. Br J Surg 104:1315–1326

    Article  PubMed  PubMed Central  CAS  Google 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):6

    Google 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 15:1109–1115

    Google Scholar 

  30. Linden A, Mantyniemi S (2011) Using the negative binomial distribution to model overdispersion in ecological count data. Ecology 92(1414–142):1

    Google 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):9

    Google 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, Washington

    Google Scholar 

  33. Lindsey JK, Jones B (1998) Choosing among generalized linear models applied to medical data. Stat Med 17(59–6):8

    Google 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):7

    Google Scholar 

  35. Stewart BT, Gyedu A, Abantanga F, Abdulai AR, Boakye G, Kushner A (2015) Barriers to essential surgical care in low- and middle-income countries: a pilot study of a comprehensive assessment tool in Ghana. World J Surg. https://doi.org/10.1007/s00268-015-3168-4

    Article  PubMed  Google Scholar 

  36. Tansley G, Stewart BT, Gyedu A, Boakye G, Lewis D, Hoogerboord M et al (2016) The correlation between poverty and access to essential surgical care in Ghana: a geospatial analysis. World J Surg. https://doi.org/10.1007/s00268-016-3765-x

    Article  PubMed  Google Scholar 

  37. Nathens AB, Jurkovich GJ, Rivara FP, Maier RV (2000) Effectiveness of state trauma systems in reducing injury-related mortality: a national evaluation. J Trauma 48:25–30 (discussion 30-21)

    Article  PubMed  CAS  Google 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 47:211–219

    Article  PubMed  PubMed Central  Google 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):I2

    Article  PubMed  PubMed Central  Google 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):5

    Google Scholar 

  41. Murray CJ, Frenk J (2000) A framework for assessing the performance of health systems. Bull World Health Organ 78(717–73):1

    Google Scholar 

  42. Sen A (1979) The tanner lecture on human values. Stanford University, Stanford

    Google Scholar 

  43. Sen A (1985) Commodities and capabilities. Oxford University Press, Amsterdam & New York, North-Holland

    Google Scholar 

  44. Stewart BT, Editorial Commentary on Bolkan et al (2016) The surgical workforce and surgical provider productivity in Sierra Leone: a countrywide inventory. World J Surg. https://doi.org/10.1007/s00268-016-3417-1

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

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.

Author information

Authors and Affiliations

  1. Department of Surgery, University of Washington, 1959 NE Pacific St., Suite BB-487, P.O. Box 356410, Seattle, WA, 98195-6410, USA

    Barclay T. Stewart, Cameron Gaskill & Charles Mock

  2. School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

    Barclay T. Stewart & Cameron Gaskill

  3. Department of Interdisciplinary Health Sciences, Stellenbosch University, Cape Town, South Africa

    Barclay T. Stewart

  4. Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

    Adam Gyedu, Robert Quansah & Peter Donkor

  5. School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

    Godfred Boakye

  6. Komfo Anokye Teaching Hospital, Kumasi, Ghana

    Robert Quansah & Peter Donkor

  7. Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa

    Jimmy Volmink

  8. Cochrane Centre, South African Medical Research Council, Parrow, South Africa

    Jimmy Volmink

  9. Harborview Injury Prevention and Research Center, Seattle, WA, USA

    Charles Mock

  10. Department of Global Health, University of Washington, Seattle, WA, USA

    Charles Mock

Authors
  1. Barclay T. Stewart
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Adam Gyedu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cameron Gaskill
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Godfred Boakye
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Robert Quansah
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Peter Donkor
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jimmy Volmink
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Charles Mock
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Barclay T. Stewart.

Ethics declarations

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.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Stewart, B.T., Gyedu, A., Gaskill, C. et al. Exploring the Relationship Between Surgical Capacity and Output in Ghana: Current Capacity Assessments May Not Tell the Whole Story. World J Surg 42, 3065–3074 (2018). https://doi.org/10.1007/s00268-018-4589-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-018-4589-7

Search

Navigation