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

  • Barclay T. Stewart
  • Adam Gyedu
  • Cameron Gaskill
  • Godfred Boakye
  • Robert Quansah
  • Peter Donkor
  • Jimmy Volmink
  • Charles Mock
Original Scientific Report
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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.

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Notes

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.

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.

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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Barclay T. Stewart
    • 1
    • 2
    • 3
  • Adam Gyedu
    • 4
  • Cameron Gaskill
    • 1
    • 2
  • Godfred Boakye
    • 5
  • Robert Quansah
    • 4
    • 6
  • Peter Donkor
    • 4
    • 6
  • Jimmy Volmink
    • 7
    • 8
  • Charles Mock
    • 1
    • 9
    • 10
  1. 1.Department of SurgeryUniversity of WashingtonSeattleUSA
  2. 2.School of Medical SciencesKwame Nkrumah University of Science and TechnologyKumasiGhana
  3. 3.Department of Interdisciplinary Health SciencesStellenbosch UniversityCape TownSouth Africa
  4. 4.Department of Surgery, School of Medical SciencesKwame Nkrumah University of Science and TechnologyKumasiGhana
  5. 5.School of Public HealthKwame Nkrumah University of Science and TechnologyKumasiGhana
  6. 6.Komfo Anokye Teaching HospitalKumasiGhana
  7. 7.Faculty of Health SciencesStellenbosch UniversityCape TownSouth Africa
  8. 8.Cochrane CentreSouth African Medical Research CouncilParrowSouth Africa
  9. 9.Harborview Injury Prevention and Research CenterSeattleUSA
  10. 10.Department of Global HealthUniversity of WashingtonSeattleUSA

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