Identifying Information Gaps in a Surgical Capacity Assessment Tool for Developing Countries: A Methodological Triangulation Approach
Surgical capacity assessment in low- and middle-income countries (LMICs) is challenging. The Surgeon OverSeas’ Personnel Infrastructure Procedure Equipment and Supplies (PIPES) survey tool has been proposed to address this challenge. There is a need to examine the gaps in veracity and context appropriateness of the information obtained using the PIPES tool.
We performed a methodological triangulation by comparing and contrasting information obtained using the PIPES tool with information obtained simultaneously via three other methods: time and motion study (T&M); provider focus group discussions (FGDs); and a retrospective review of hospital records.
In its native state, the PIPES survey does not capture the role of non-physician clinicians who contribute immensely to surgical care delivery in LMICs. The surgical workforce was more accurately captured by the FGDs and T&M. It may also not reflect the improvisations (e.g., patients sharing beds, partitioning the operating theater, and using preoperative rooms for surgery, etc.) that occur to expand surgical capacity to overcome the limited infrastructure and equipment.
The PIPES tool captures vital surgical capacity information but has gaps that can be filled by modifying the tool and/or using ancillary methodologies. The interests of the researcher and the local stakeholders’ perspectives should inform such modifications.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Informed consent was obtained from all individual participants included in the study.
- 1.World Health Organization (2015) WHO | Tracking universal health coverage: first global monitoring reportGoogle Scholar
- 2.World Health Organization, The World Bank (2017) Tracking universal health coverage: 2017 global monitoring report. doi:Licence: CC BY-NC-SA 3.0 IGOGoogle Scholar
- 3.Price R, Makasa E, Hollands M (2015) World Health Assembly Resolution WHA68.15: “strengthening emergency and essential surgical care and anesthesia as a component of universal health coverage”—addressing the public health gaps arising from lack of safe, affordable and accessible surgical anesthetic services. World J Surg 39:2115–2125. https://doi.org/10.1007/s00268-015-3153-y CrossRefGoogle Scholar
- 4.World Health Organization (2016) Universal health coverage (UHC). WHO factsheet. http://www.who.int/mediacentre/factsheets/fs395/en/. Accessed 10 Oct 2017
- 8.Mazumdar T (2015) Five billion people ‘have no access to safe surgery’. BBC News. BBC News. http://www.bbc.com/news/health-32452249. Accessed 21 Aug 2015
- 12.The Lancet Commission on Global Surgery (2015) Global surgery 2030: implementation. http://www.lancetglobalsurgery.org/implementation-tools. Accessed 10 Oct 2017
- 14.World Health Organization (n.d.) Tool for situational analysis to assess emergency and essential surgical care. https://www.who.int/surgery/publications/s15986e.pdf?ua=1. Accessed 10 Oct 2017
- 15.Surgeons OverSeas (n.d.) SOS PIPES surgical capacity assessment tool. https://www.surgeonsoverseas.org/resources/. Accessed 12 Aug 2015
- 16.Holtzhausen S (2001) Triangulation as a powerful tool to strengthen the qualitative research design: the Resource-based Learning Career Preparation Programme (RBLCPP) as a case study. In: High Education Close Up Conference 2, Lancaster University, pp 2–5Google Scholar
- 17.Denzin NK (2009) Strategies for multiple triangulation. In: the research act: a theoretical introduction to sociological methods, 3rd edn. Taylor & Francis Group, New York, pp 297-313Google Scholar
- 20.Debas HT, Gosselin R, McCord C, Thind A (2006) Surgery. In: Jamison DT, Breman JG, Measham AR, et al (eds) Disease control priorities in developing countries, 2nd edn. Oxford University Press, New York, pp 1245–1260Google Scholar
- 21.Henry JA, Orgoi S, Govind S, Price RR, Lundeg G, Kehrer B (2012) Strengthening surgical services at the soum (First-referral) hospital: the WHO Emergency and Essential Surgical Care (EESC) Program in Mongolia. World J Surg 36:2359–2370. https://doi.org/10.1007/s00268-012-1668-z CrossRefGoogle Scholar
- 27.Pereira C, Cumbi A, Malalane R, Vaz F, McCord C, Bacci A et al (2007) Meeting the need for emergency obstetric care in Mozambique: work performance and histories of medical doctors and assistant medical officers trained for surgery. BJOG Int J Obstet Gynaecol 114:1530–1533. https://doi.org/10.1111/j.1471-0528.2007.01489.x CrossRefGoogle Scholar