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Quantifying Surgical and Anesthetic Availability at Primary Health Facilities in Mongolia

World Journal of Surgery volume 35, pages 272–279 (2011)Cite this article

Abstract

Background

Significant barriers limit the safe and timely provision of surgical and anaesthetic care in low- and middle-income countries. Nearly one-half of Mongolia’s population resides in rural areas where the austere geography makes travel for adequate surgical care very difficult. Our goal was to characterize the availability of surgical and anaesthetic services, in terms of infrastructure capability, physical resources (supplies and equipment), and human resources for health at primary level health facilities in Mongolia.

Methods

A situational analysis of the capacity to deliver emergency and essential surgical care (EESC) was performed in a nonrandom sample of 44 primary health facilities throughout Mongolia.

Results

Significant shortfalls were noted in the capacity to deliver surgical and anesthetic services. Deficiencies in infrastructure and supplies were common, and there were no trained surgeons or anaesthesiologists at any of the health facilities sampled. Most procedures were performed by general doctors and paraprofessionals, and occasionally visiting surgeons from higher levels of the health system. While basic interventions such as suturing or abscess drainage were commonly performed, the availability of many essential interventions was absent at a significant number of facilities.

Conclusions

This situational analysis of the availability of essential surgical and anesthetic services identified significant deficiencies in infrastructure, supplies, and equipment, as well as a lack of human resources at the primary referral level facilities in Mongolia. Given the significant travel distances to secondary level facilities for the majority of the rural population, there is an urgent need to strengthen the delivery of essential surgical and anaesthetic services at the primary referral level (soum and intersoum). This will require a multidisciplinary, multi-sectoral effort aimed to improve infrastructure, procure and maintain essential equipment and supplies, and train appropriate health professionals.

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Acknowledgments

The authors acknowledge the contributions of Dr. Lundeg Ganbold, Dr. Sereenen Enkhbold, and Adam Idriss, all of whom were involved in the collection of data and in reviewing the final manuscript.

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Affiliations

  1. Division of Orthopaedic Surgery, Childrens Hospital of Philadelphia, 2nd Floor Wood Building, 34th Street and Civic Center Blvd, Philadelphia, PA, 19104, USA

    David A. Spiegel

  2. Department of Surgery S1, Health Sciences University, Choidog-3 Street, 210648, Ulaanbaatar, Mongolia

    Sergelen Orgoi

  3. Swanson Family Foundation, Intermountain Healthcare, 1923 E. Browning Ave, Salt Lake City, UT, 84108, USA

    Raymond R. Price

  4. Department of Public Health, WHO Representative Office, Government Building-VII, Ulaanbaatar, Mongolia

    Salik Govind

  5. Emergency and Essential Surgical Care Project, Clinical Procedures Unit, Department of Essential Health Technologies, World Health Organization, Geneva, Switzerland

    Meena Cherian

  6. Swiss Surgical Team, International College of Surgeons (ICS), Tutilostrasse 5, 9011, St. Gallen, Switzerland

    Beat Kehrer

  7. Johns Hopkins University, 600 N. Wolfe St, Baltimore, MD, 21231, USA

    Shelly Choo

Authors
  1. David A. Spiegel
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  2. Shelly Choo
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  3. Meena Cherian
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  4. Sergelen Orgoi
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  5. Beat Kehrer
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  6. Raymond R. Price
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  7. Salik Govind
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Corresponding author

Correspondence to David A. Spiegel.

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Spiegel, D.A., Choo, S., Cherian, M. et al. Quantifying Surgical and Anesthetic Availability at Primary Health Facilities in Mongolia. World J Surg 35, 272–279 (2011). https://doi.org/10.1007/s00268-010-0904-7

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  • DOI: https://doi.org/10.1007/s00268-010-0904-7

Keywords

  • Health Facility
  • Physical Resource
  • Level Facility
  • Primary Health Facility
  • Level Health Facility