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Access to Safe, Timely, and Affordable Surgical Care in Uganda: A Stratified Randomized Evaluation of Nationwide Public Sector Surgical Capacity and Core Surgical Indicators

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Abstract

Background

Access to safe surgery is critical to health, welfare, and economic development. In 2015, the Lancet Commission on Global Surgery recommended that all countries collect surgical indicators to lend insight into improving surgical care. No nationwide high-quality data exist for these metrics in Uganda.

Methods

A standardized quantitative hospital assessment and a semi-structured interview were administered to key stakeholders at 17 randomly selected public hospitals. Hospital walk-throughs and retrospective reviews of operative logbooks were completed.

Results

This study captured information for public hospitals serving 64.0% of Uganda’s population. On average, <25% of the population had 2 h access to a surgically capable facility. Hospitals averaged 257 beds/facilities and there were 0.2 operating rooms per 100,000 people. Annual surgical volume was 144.5 cases per 100,000 people per year. Surgical, anesthetic, and obstetrician physician workforce density was 0.3 per 100,000 people. Most hospitals reported having electricity, oxygen, and blood available more than half the time and running water available at least three quarters of the time. In total, 93.8% of facilities never had access to a CT scan. Sterile gloves, nasogastric tubes, and Foley catheters were frequently unavailable. Uniform outcome reporting does not exist, and the WHO safe surgery checklist is not utilized.

Conclusion

The Ugandan public hospital system does not meet LCoGS targets for surgical access, workforce, or surgical volume. Critical policy and programmatic developments are essential to build surgical capacity and facilitate provision of safe, timely, and affordable surgical care. Surgery must become a public health priority in Uganda and other low resource settings.

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Acknowledgments

We are grateful to our collaborating partners and the hospitals and staff that participated in this assessment. Many thanks in particular to our colleagues at MOH whose partnership ensured a comprehensive evaluation, access to facilities, and applicability and accessibility of results at the country level. Funding was provided by the MGH Global Surgery Fund, MGH Center for Global Health, and Program in Global Surgery and Social Change.

Funding

Funding for this research was provided by the MGH Global Surgery Fund, MGH Center for Global Health, and Program in Global Surgery and Social Change.

Author information

Authors and Affiliations

  1. Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA

    Katherine Albutt, Maria Punchak, Geoffrey A. Anderson & Mark G. Shrime

  2. Department of Surgery, Massachusetts General Hospital (MGH), Boston, MA, USA

    Katherine Albutt & Geoffrey A. Anderson

  3. David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Maria Punchak

  4. Mbarara University of Science and Technology (MUST), Mbarara, Uganda

    Peter Kayima

  5. Ministry of Health (MOH), Kampala, Uganda

    Didacus B. Namanya

  6. Uganda Martyrs University (UMU), Nkozi, Uganda

    Didacus B. Namanya

  7. Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA

    Mark G. Shrime

Authors
  1. Katherine Albutt
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  2. Maria Punchak
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  3. Peter Kayima
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  4. Didacus B. Namanya
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  5. Geoffrey A. Anderson
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  6. Mark G. Shrime
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Corresponding author

Correspondence to Katherine Albutt.

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Conflict of interest

The authors declare that they have no conflict of interest

Appendix: statistics

Appendix: statistics

Relationship between access to bellwether facility and region

  • Ho = no relationship between access to bellwether facility and region

  • Ha = relationship between access to bellwether facility and region

  • Test = Fisher’s exact test

Relationship between hospital type and medications (composite score)

  • Ho = no relationship between hospital type and medications (composite score)

  • Ha = relationship between hospital type and medications (composite score)

  • Test = Fisher’s exact test

  • Relationship between hospital type and blood

  • Ho = no relationship between hospital type and blood

  • Ha = relationship between hospital type and blood

  • Test = Fisher’s exact test

Relationship between operative volume (absolute and relative) and the type of hospital

  • Ho = no relationship between hospital type and operative volume

  • Ha = relationship between hospital type and operative volume

  • Test = two-sample t test

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Albutt, K., Punchak, M., Kayima, P. et al. Access to Safe, Timely, and Affordable Surgical Care in Uganda: A Stratified Randomized Evaluation of Nationwide Public Sector Surgical Capacity and Core Surgical Indicators. World J Surg 42, 2303–2313 (2018). https://doi.org/10.1007/s00268-018-4485-1

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  • DOI: https://doi.org/10.1007/s00268-018-4485-1

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