World Journal of Surgery

, Volume 34, Issue 3, pp 473–479 | Cite as

Emergency and Essential Surgical Services in Afghanistan: Still a Missing Challenge

  • Sandro Contini
  • Asadullah Taqdeer
  • Meena Cherian
  • Ahmad Shah Shokohmand
  • Richard Gosselin
  • Peter Graaff
  • Luc Noel
Article

Abstract

Background

In Afghanistan, the number of surgically amenable injuries related to civil unrest and ongoing conflict or consequent to road traffic accidents, trauma, or pregnancy-related complications is rising and becoming a major cause of death and disability. This study was designed to evaluate availability of basic lifesaving and disability-preventive emergency surgical and anesthesia interventions representing most of the country.

Methods

Evaluation was performed outside Kabul to represent a cross-section of the country. Data were collected from Afghanistan health facilities, using the WHO Tool for Situation Analysis to Assess Emergency and Essential Surgical Care, covering case volume, travel distances, infrastructures, human resources, supplies, equipment, and interventions characterizing basic trauma, surgery, and anesthesia capacities.

Results

In 30% of the 17 facilities examined, oxygen supply is limited and irregular; uninterrupted running water is not accessible in 40%; electrical power is not available continuously in 66%. Shortage of equipment and personnel is evident in peripheral health facilities: certified surgeons are present in 63.6% and certified anesthesiologists in 27.2%. Continuous 24 h surgical service is available in 29.4%. Lifesaving procedures are performed in 17–42% of peripheral hospitals; 23.5% are without emergency obstetric service.

Conclusions

Limited access to surgery is highly remarkable in Afghanistan, with a severe shortage of emergency surgical capacities in provincial and district hospitals, where availability of basic and emergency surgical care is far from satisfactory. A comprehensive approach for strengthening basic surgical capacities at the primary health care level should be introduced.

References

  1. 1.
    Debas HT, Gosselin RA, McCord C et al (2006) Surgery. In: Jamison D, Evans D, Alleyne G et al (eds) Disease control priorities in developing countries, 2nd edn. Oxford University Press, New York, pp 1245–1260Google Scholar
  2. 2.
    Emergency and essential surgical care. Global Initiative for Emergency and Essential Surgical Care (GIEESC). http://www.who.int/surgery/en/
  3. 3.
    Integrated Management for Emergency and Essential Surgical Care (IMEESC) tool kit. http://www.who.int/surgery/publications/imeesc/en/index.html
  4. 4.
    A Basic Package of Health Services for Afghanistan (2005) http://www.msh.org/afghanistan/pdf/Afghanistan_BPHS_2005_1384.pdf
  5. 5.
    Afghanistan national hospital survey: final report [electronic resource]/Ministry of Health, Transitional Islamic state of Afghanistan (2004) http://www.msh.org/afghanistan/pdf/Afghanistan_National_Hospital_Survey.pdf
  6. 6.
    Pavignani E, Colombo S (2002) Afghanistan Health Sector Profile. http://www.aims.org.af/services/sectoral/health/health_sector_profile_aug_02.pdf
  7. 7.
    Ministry of Public Health of Afghanistan, Johns Hopkins Bloomberg School of Public Health, Indian Institute of Health Management Research. Afghanistan Health Sector Balanced Scorecard: National and Provincial Results (2006) http://www.moph.gov.af/hmis-reports/BSC_2006_Report.pdf
  8. 8.
    Tool for Situational Analysis to Assess Emergency and Essential Surgical Care. http://www.who.int/surgery/publications/QuickSitAnalysisEESCsurvey.pdf
  9. 9.
    Kingham TP, Kamara TB, Cherian M et al (2009) Quantifying surgical capacity in Sierra Leone, A guide for improving surgical care. Arch Surg 144:123–127Google Scholar
  10. 10.
    Central Intelligence Agency. The World Factbook. https://www.cia.gov/library/publications/the-world-factbook/
  11. 11.
    Gosselin RA, Spiegel DA, Coughlinc R et al (2009) Injuries: the neglected burden in developing countries. Bull World Health Organ 87:246CrossRefPubMedGoogle Scholar
  12. 12.
    Lowenberg S (2009) Afghanistan’s hidden health issue. Lancet 374:1987–1988Google Scholar
  13. 15.
    Sabri B, Siddiqi S, Ahmed AM et al (2007) Towards sustainable delivery of health services in Afghanistan: options for the future. Bull World Health Organ 85:712–718CrossRefPubMedGoogle Scholar
  14. 16.
    Report of the Health System Review Mission-Afghanistan. Challenges and the Way Forward. World Health Organization Eastern Mediterranean Regional Office (2006) http://gis.emro.who.int/HealthSystemObservatory/PDF/HealthSystemReviewMissionReports/Afg%20Mission%20Report%20Draft%202.pdf
  15. 17.
    Peters DH, Ahmed Noor A, Singh LP et al (2007) A balanced scorecard for health services in Afghanistan. Bull World Health Organ 85:146–151CrossRefPubMedGoogle Scholar
  16. 18.
    Bristol N (2005) Reconstructing Afghanistan’s health system. Lancet 366:2075–2076CrossRefPubMedGoogle Scholar
  17. 19.
    Farmer PE, Kim JY (2008) Surgery and global health: a view from beyond the OR. World J Surg 32:533–535CrossRefPubMedGoogle Scholar
  18. 20.
    Weiser TG, Regenbogen SE, Thompson KD et al (2008) An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet 372:139–144CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2010

Authors and Affiliations

  • Sandro Contini
    • 1
  • Asadullah Taqdeer
    • 2
  • Meena Cherian
    • 3
  • Ahmad Shah Shokohmand
    • 4
  • Richard Gosselin
    • 5
  • Peter Graaff
    • 2
  • Luc Noel
    • 3
  1. 1.Department of Surgical SciencesUniversity of ParmaParmaItaly
  2. 2.World Health Organization (WHO) Country OfficeKabulAfghanistan
  3. 3.Department of Essential Health Technologies, Health Systems and ServicesWHOGenevaSwitzerland
  4. 4.Health Services Provision, Ministry of Public HealthKabulAfghanistan
  5. 5.Institute for Global Orthopedics and Traumatology, Department of Orthopedic SurgeryUniversity of San Francisco, California (UCSF)San FranciscoUSA

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