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Provision of Surgical Care for Children Across Somaliland: Challenges and Policy Guidance

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Abstract

Background

Existing data suggest a large burden of surgical conditions in low- and middle-income countries (LMICs). However, surgical care for children in LMICs remains poorly understood. Our goal was to define the hospital infrastructure, workforce, and delivery of surgical care for children across Somaliland and provide policy guidance to improve care.

Methods

We used two established hospital assessment tools to assess infrastructure, workforce, and capacity at all hospitals providing surgical care for children across Somaliland. We collected data on all surgical procedures performed in children in Somaliland between August 2016 and July 2017 using operative logbooks.

Results

Data were collected from 15 hospitals, including eight government, five for-profit, and two not-for-profit hospitals. Children represented 15.9% of all admitted patients, and pediatric surgical interventions comprised 8.8% of total operations. There were 0.6 surgical providers and 1.2 anesthesia providers per 100,000 population. A total of 1255 surgical procedures were performed in children in all hospitals in Somaliland over 1 year, at a rate of 62.4 surgical procedures annually per 100,000 children. Care was concentrated at private hospitals within urban areas, with a limited number of procedures for many high-burden pediatric surgical conditions.

Conclusions

We found a profound lack of surgical capacity for children in Somaliland. Hospital-level surgical infrastructure, workforce, and care delivery reflects a severely resource-constrained health system. Targeted policy to improved essential surgical care at local, regional, and national levels is essential to improve the health of children in Somaliland.

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Acknowledgements

We want to thank the Global Initiative for Children's Surgery (GICS) for its support of this work. GICS (www.globalchildrenssurgery.org) is a network of children's surgical and anesthesia providers from low-, middle-, and high-income countries collaborating for the purpose of improving the quality of surgical care for children globally.

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Authors and Affiliations

  1. Duke Global Health Institute, Duke University, Durham, NC, USA

    Tessa L. Concepcion, Emily R. Smith & Henry E. Rice

  2. Department of Public Health, Baylor University, Waco, TX, 76706, USA

    Emily R. Smith

  3. Edna Adan University Hospital, Hargeisa, Somaliland, Somalia

    Mubarak Mohamed, Shugri Dahir & Edna Adan Ismail

  4. King’s Centre for Global Health and Health Partnerships, King’s College London, London, UK

    Andrew J. M. Leather

  5. McGill University, Montreal, QC, Canada

    Dan Poenaru

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  1. Tessa L. Concepcion
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Concepcion, T.L., Smith, E.R., Mohamed, M. et al. Provision of Surgical Care for Children Across Somaliland: Challenges and Policy Guidance. World J Surg 43, 2934–2944 (2019). https://doi.org/10.1007/s00268-019-05079-8

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