Liberian Surgical and Anesthesia Infrastructure: A Survey of County Hospitals
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There is a significant burden of disease in low-income countries that can benefit from surgical intervention. The goal of this survey was to evaluate the current ability of the Liberian health care system to provide safe surgical care and to identify unmet needs in regard to trained personnel, equipment, infrastructure, and outcomes measurement.
A comprehensive survey tool was developed to assess physical infrastructure of operative facilities, education and training for surgical and anesthesia providers, equipment and medications, and the capacity of the surgical system to collect and evaluate surgical outcomes at district-level hospitals in Africa. This tool was implemented in a sampling of 11 county hospitals in Liberia (January 2011). Data were obtained from the Ministry of Health and by direct government-affiliated hospital site visits.
The total catchment area of the 11 hospitals surveyed was 2,313,429—equivalent to roughly 67 % of the population of Liberia (3,476,608). There were 13 major operating rooms and 34 (1.5 per 100,000 population) physicians delivering surgical, obstetric, or anesthesia care including 2 (0.1 per 100,000 population) who had completed formal postgraduate training programs in these specialty areas. The total number of surgical cases for 2010 was 7,654, with approximately 43 % of them being elective procedures. Among the facilities that tracked outcomes in 2010, a total of 11 intraoperative deaths (145 per 100,000 operative cases) were recorded for 2009. The 30-day postoperative mortality at hospitals providing data was 44 (1,359 per 100,000 operative cases). Metrics were also used to evaluate surgical output, safety of anesthesia, and the burden of obstetric disease.
A significant volume of surgical care is being delivered at county hospitals throughout Liberia. The density and quality of appropriately trained personnel and infrastructure remain critically low. There is strong evidence for continued development of emergency and essential surgical services, as well as improved surgical outcomes tracking, at county hospitals in Liberia. These results serve to inform the international community and donors of the ongoing global surgical and anesthesia crisis.
KeywordsPulse Oximetry County Hospital Anesthesia Care Anesthesia Provider Heavily Indebted Poor Country
The authors thank the Republic of Liberia Ministry of Health and Social Welfare as well as William E. Martin for their support and assistance in providing countrywide data.
- 1.Debas HT, Gosselin R, McCord C et al (2006) Surgery. In: Jamison DT, Breman JG, Measham AR et al (eds) Disease control priorities in developing countries. Oxford University Press, New York, pp 1245–1260Google Scholar
- 13.Central Intelligence Agency (2012) The World FactbookGoogle Scholar
- 14.Liberia Institute of Statistics and Geo-Information Services (2009) 2008 National population and housing census final results. Monrovia, LiberiaGoogle Scholar
- 15.Republic of Liberia Ministry of Planning and Economic Affairs (2006) United Nations Development Program National Human Development report 2006Google Scholar
- 17.United Nations Development Program (2010) The real wealth of nations: pathways to human development. Palgrave MacMillan, New YorkGoogle Scholar
- 18.Republic of Liberia Ministry of Planning and Economic Affairs (2010) Millennium Development Goals 2010 reportGoogle Scholar
- 19.Liberia Institute of Statistics and Geo-Information Services (2008) Liberia demographic and health survey 2007. Monrovia, LiberiaGoogle Scholar
- 20.World Health Organization (2009) WHO country cooperation strategy 2008–2011. WHO Regional Office for Africa, BrazzavilleGoogle Scholar
- 21.Liberia Institute of Statistics and Geo-Information Services (2010) The national census of health workers in Liberia 2009. Monrovia, LiberiaGoogle Scholar
- 23.Peel D, Howie SRC (2009) Oxygen concentrators for use in tropical countries: a survey. J Clin Eng 34:205–209Google Scholar