Surgical Capacity at District Hospitals in Zambia: From 2012 to 2016
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Sub-Saharan Africa has one of the highest burdens of surgically treatable conditions in the world and the highest unmet need, especially in rural areas. Zambia is one of the countries in the region taking steps to improve surgical care for its rural populations.
To demonstrate changes in surgical capacity in Zambia’s district hospitals over a 3-year period and to provide a baseline from which future interventions in surgical care can be assessed.
A cross-sectional assessment of surgical capacity, using a modified WHO questionnaire, was administered in first-level hospitals in nine of Zambia’s ten provinces between November 2012 and February 2013 and again between February and April 2016. The two assessments allowed measurement of changes in surgical workforce, infrastructure, equipment, drugs and consumables; and numbers of major surgical procedures performed over two 12-month periods prior to the assessments.
There was a significant increase, 2013–2016, in number of theatre staff, from 174 (mean 4.4; SD 1.7) to 235 (mean 6; SD 2.9), P = 0.02. However, the percentage of hospitals with functioning anaesthetic machines dropped from 64 to 41%. There was also a drop in hospitals reporting availability of instruments, drugs and consumables from 38 to 24 (97–62%) and from 28 to 24 (72–62%), respectively. The median number of caesarean sections in 2012 was 99 [interquartile range (IQR) 42–187] and 100 (IQR 42–126) in 2015 (P value =0.53). The median number of major surgical procedures in 2012 was 54 (IQR 10–113) and 66 (IQR 18–168) in 2015 (P = 0.45).
An increase in the first-level hospital surgical workforce between 2013 and 2016 was accompanied by reductions in essential equipment and consumables for surgery, and no changes in surgical output. Periodic monitoring of resource availability is needed to address shortages and make safe surgery available to rural populations.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 2.World Health Organisation. WHO global initiative for emergency and essential surgical care sixth biennial and tenth anniversary meeting. 2015;Google Scholar
- 8.Horton S, Alderman H, Rivera JA. Copenhagen Consensus 2008. 2008;1–40Google Scholar
- 9.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(3):500–504. https://doi.org/10.1007/s00268-010-0918-1 CrossRefPubMedGoogle Scholar
- 13.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(4):813–821. https://doi.org/10.1007/s00268-014-2938-8 CrossRefPubMedGoogle Scholar
- 14.MOH. The 2012 List of Health Facilities in Zambia Preliminary Report. 2013;(15)Google Scholar
- 15.CSO. Zambia 2010 census of population and housing: National analytical report. 2012Google Scholar
- 17.Republic of Zambia Ministry of Health. National Health Strategic Plan 2011–2015. 2011;1–99Google Scholar
- 20.Kamwanga J, Koyi G, Mwila J, Musonda M BR. Understanding the labour market of human resources for health in Zambia. WHO [Internet]. 2013;(November):23. http://www.who.int/hrh/tools/Sudan%7B_%7Dfinal.pdf
- 23.Health MOF. Republic of Zambia Ministry of Health National Surgical, Obstetric, and Anaesthesia Strategic Plan (Nsoasp) year 2017–2021. 2017Google Scholar
- 24.Gajewski J, Conroy R, Bijlmakers L, Mwapasa G, McCauley T, Borgstein E et al (2018) Quality of surgery in Malawi: comparison of patient-reported outcomes after hernia surgery between district and central hospitals. World J Surg 42(6):1610–1616. https://doi.org/10.1007/s00268-017-4385-9 CrossRefPubMedGoogle Scholar
- 25.Technologies H. Tool for situational analysis to assess emergency and essential surgical careGoogle Scholar
- 32.Greenleaf AR, Gibson DG, Khattar C, Labrique AB, Pariyo GW. Building the evidence base for remote data collection in low- and middle-income countries: comparing reliability and accuracy across survey modalities. Rosskam E, Hyder A, editors. vol. 19, Journal of Medical Internet Research. 2017Google Scholar