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Assessment of Surgical Care Provided in National Health Services Hospitals in Mozambique: The Importance of Subnational Metrics in Global Surgery

  • Surgery in Low and Middle Income Countries
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Introduction

Surgery plays a critical role in sustainable healthcare systems. Validated metrics exist to guide implementation of surgical services, but low-income countries (LIC) struggle to report recommended metrics and this poses a critical barrier to addressing unmet need. We present a comprehensive national sample of surgical encounters from a LIC by assessing the National Health Services of Mozambique.

Material and methods

A prospective cohort of all surgical encounters from Mozambique’s National Health Service was gathered for all provinces between July and December 2015. Primary outcomes were timely access, provider densities for surgery, anesthesiology, and obstetrics (SAO) per 100,000 population, annualized surgical procedure volume per 100,000, and postoperative mortality (POMR). Secondary outcomes include operating room density and efficiency.

Results

Fifty-four hospitals had surgical capacity in 11 provinces with 47,189 surgeries. 44.9% of Mozambique’s population lives in Districts without access to surgical services. National SAO density was 1.2/100,000, ranging from 0.4/100,000 in Manica Province to 9.8/100,000 in Maputo City. Annualized national surgical case volume was 367 procedures/100,000 population, ranging from 180/100,000 in Zambezia Province to 1,897/100,000 in Maputo City. National POMR was 0.74% and ranged from 0.23% in Maputo Province to 1.78% in Niassa Province.

Discussion

Surgical delivery in Mozambique falls short of international targets. Subnational deficiencies and variations between provinces pose targets for quality improvement in advancing national surgical plans. This serves as a template for LICs to follow in gathering surgical metrics for the WHO and the World Bank and offers short- and long-term targets for surgery as a component of health systems strengthening.

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Acknowledgements

We would like to acknowledge Dr. Ussene Isse and all his team as the National Director of the Medical Assistance Directorate at the Ministry of Health of Mozambique. We also wish to thank our staff and collaborators at the Mozambique Institute for Health Education and Research (MIHER) who gave the institutional and administrative support which made this work possible. A special thanks to my research team, Drs. Adriano Tivane, Amâncio Oliveira, Clotilde Nhatave, Ivandra Magaia, Micail Julaya, Monica Muataco, Nelson Mucopo, Paulo Gudo, Thiago Machado de Oliveira, Tyler Robinson, Jamie Anderson, all the nonphysician surgeons, administrative personnel, and health managers who took part in this work.

Funding

This project was supported by United States National Institutes of Health through the Fogarty International Center and University of California Global Health Institute (UCGHI), grant numbers R25TW009343 and R25TW011216.

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Authors and Affiliations

  1. Department of Surgery, Maputo Central Hospital, Eduardo Mondlane University, Maputo, Mozambique

    Matchecane Cossa

  2. Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA

    John Rose

  3. Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California, San Diego, CA, USA

    Allison E. Berndtson

  4. Microbiology Department, Parasitology Laboratory, Department of Medicine, Eduardo Mondlane University, Maputo, Mozambique

    Emilia Noormahomed

  5. Mozambique Institute of Health Education and Research, Maputo, Mozambique

    Emilia Noormahomed

  6. Department of Medicine, Division of Infectious Diseases, University of California, San Diego, CA, USA

    Emilia Noormahomed

  7. Division of Pediatric Surgery, Rady Children’s Hospital, University of California, San Diego, CA, USA

    Stephen W. Bickler

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  1. Matchecane Cossa
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Correspondence to John Rose.

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Cossa, M., Rose, J., Berndtson, A.E. et al. Assessment of Surgical Care Provided in National Health Services Hospitals in Mozambique: The Importance of Subnational Metrics in Global Surgery. World J Surg 45, 1306–1315 (2021). https://doi.org/10.1007/s00268-020-05925-0

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