Inadequate surgical provision in African district general hospitals

Two papers published this week in PLoS Medicine by Margaret Kruk and colleagues investigate surgical provision in eight district hospitals in three sub-Saharan African countries. The authors, from the USA and Africa, show low levels of surgical care provision, a lack of specialist surgeons and anaesthetists, and low expenditure on surgical provision.

Conditions that require surgery, including complications of childbirth and traumatic injuries, are common in developing countries and contribute significantly to the burden of disease in these countries. Several initiatives are underway to increase surgical provision globally including those of the Bellagio Essential Surgery Group, some of whose members contributed to this paper. However, little is currently known about the extent of surgical provision outside of the rich world, and hence what the unmet need for surgical provision really is.

In the first paper the authors report that surgical provision comprised mainly essential and life-saving emergency procedures. Surgical procedures varied across hospitals but were low, ranging from five to 45 major procedures per 10,000 people served. The number of beds in the studied hospitals was also low, ranging from 0.2 to 1.0 per 1,000 population. In the second paper, which examined human resource and funding constraints for surgery, the authors report no specialist surgeons or anaesthetists in any of the hospitals studied; surgery was done by general doctors or health providers not qualified in surgery. The per capita expenditure on surgery was very low, ranging from US$0.05 to US$0.14 in the eight hospitals.

These findings indicate a shockingly low level of surgical provision in these settings. Although these results may not necessarily be generalizable to other district hospitals in sub-Saharan Africa they do provide a valuable baseline for planning the expansion of health care services in Africa.