Hurdles to the Development of the “Surgical Home” in the Low-Resource World

  • Akwasi Antwi-KusiEmail author
  • Alfred Jacob Aidoo
Global Health Anesthesia (MJ Harris, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Global Health Anesthesia


Purpose of Review

This chapter assesses the current state of practice of anesthesia in a low-resourced hospital and the hurdles envisaged in the development of perioperative surgical home, PSH, at the Komfo Anokye Teaching Hospital, KATH in Ghana.

Recent Findings

In the PSH model, the patient’s experience of care is coordinated by a Director of Perioperative Services, additional Surgical Home Leadership, and supportive personnel, which constitute an interdisciplinary team. KATH is yet to establish working structures that provide a solid foundation that would make implementation of this model possible. Foundational tenets of the PSH being operating room (OR) managers or directors, interdisciplinary teamwork, well-oriented and motivated staff, appreciation of the key roles of the anesthetist by both patients and surgeons among others are either not well established or nonexistent currently at KATH.


While KATH has the basic infrastructure and personnel compared to other low-resourced countries for delivery of safe anesthesia, there exist several important limitations to the successful establishment of the PSH practice. Besides having to operate currently on limited funding, the necessary interdepartmental cohesion and acceptance of the anesthetist to lead any such model present an important hurdle to be surmounted.


Perioperative surgical home Low-resourced world Anesthesia Motivation Incentives Morale Workforce Interdisciplinary team Attitude to work Targets 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Desebbe O, Lanz T, Kain Z, Cannesson M. The perioperative surgical home: an innovative, patient-centered and cost-effective perioperative care model. Anaesth Crit Care Pain Med. 2016;35:59–66.CrossRefGoogle Scholar
  2. 2.
    •• Brouillette MA, Aidoo AJ, Honduras M, Boateng NA, Antwi-Kusi A, Addison W, et al. Anesthesia capacity in Ghana: a teaching hospital’s resources, and the national workforce and education. Anesth Analg. 2017;125(6):2063–71 Describes a teaching hospital’s resources and the national workforce and education in a low-resourced country. CrossRefGoogle Scholar
  3. 3.
    Chayla PL, Gilyoma JM, Mabula JB, Simbila S, Ngayolema AB, Mahalu W. Incidence, causes, and pattern of cancellations of elective surgical operations in a university teaching hospital in the Lake Zone, Tanzania. Afr Health Sci. 2011;11(3):438–43.Google Scholar
  4. 4.
    Ezike HA, Amucheazi AO, Ajuzieoegu VO. Pre-operative anaesthesia visit: problems in a University Teaching Hospital in Enugu, South East Nigeria. Ann Med Health Sci Res. 2011;1(1):97–101.Google Scholar
  5. 5.
    •• Djabletey R, Aryee G, Essuman R, Ganu V, Darkwa EO, Owoo C, et al, Patients’ knowledge and perception of anaesthesia and the anaesthetist at a tertiary health care facility in Ghana. S Afr J Anaesth Analg. 2017;23:(1). This article gives a great picture of the general perceptions held of anesthesia and the anesthetist in most tertiary health care facilities in Ghana. Google Scholar
  6. 6.
    Hoyler M, Finlayson SR, McClain CD, Meara JG, Hagander L. Shortage of doctors, shortage of data: a review of the global surgery, obstetrics, and anesthesia workforce literature. World J Surg. 2014;38:269–80.CrossRefGoogle Scholar
  7. 7.
    Cosgrove JF. Anesthetic pre-assessment clinics. Anesthesia. 2000;55:405–6.CrossRefGoogle Scholar
  8. 8.
    Kain ZN, Vakharia S, Garson L, Engwall S, Schwarzkopf R, Gupta R, et al. The perioperative surgical home as a future perioperative practice model. Anesth Analg. 2014;118:1126–30.CrossRefGoogle Scholar
  9. 9.
    Akazili J, McIntyre D, Kanmiki EW, Gyapong J, Oduro A, Sankoh O, et al. Assessing the catastrophic effects of out-of-pocket healthcare payments prior to the uptake of a nationwide health insurance scheme in Ghana. Glob Health Action. 2017;10:1289735.CrossRefGoogle Scholar
  10. 10.
    World Health Organization. The world health report 2010 - health systems financing: the path to universal coverage. Geneva: World Health Organization; 2010.Google Scholar
  11. 11.
    • Adua E, Frimpong K, Li X, Wang W. Emerging issues in public health: a perspective on Ghana’s healthcare expenditure, policies and outcomes. EPMA J. 2017;8(3):197–206 National healthcare expenditure, its impact on health outcome and health service providers in Ghana. CrossRefGoogle Scholar
  12. 12.
    •• Anabah T, Dordunoo D, Kampo S, Appiah-Denkyira E, Kaba S. Anaesthesia services in Ghana – a descriptive study. SAS J Med. 2017;3(3):49–54 Published in 2017, this descriptive study gives an excellent assessment of current anesthesia services in Ghana, its challenges and impact on usage. Google Scholar
  13. 13.
    Cannesson M, Kain Z. The perioperative surgical home: an innovative clinical care delivery model. J Clin Anesth. 2015;27:185–7.CrossRefGoogle Scholar
  14. 14.
    Prielipp RC, Morell RC, Coursin DB, Brull SJ, Barker SJ, Rice MJ, et al. The future of anesthesiology: should the perioperative surgical home redefine us? Anesth Analg. 2015;150:1142–8.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Anaesthesiology and Intensive Care, School of Medical Sciences, College of Health SciencesKwame Nkrumah University of Science and TechnologyKumasiGhana
  2. 2.Department of Anaesthesiology and Intensive CareKomfo Anokye Teaching Teaching HospitalKumasiGhana

Personalised recommendations