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Deficiencies in the Availability of Essential Musculoskeletal Surgical Services at 883 Health Facilities in 24 Low- and Lower-Middle-Income Countries

World Journal of Surgery volume 39, pages 1421–1432 (2015)Cite this article

Abstract

Background

The sequelae of acute musculoskeletal conditions, especially injuries and infections, are responsible for significant disability in low- and middle-income countries. This study characterizes the availability of selected musculoskeletal surgical services at different tiers of the health system in a convenience sample of 883 health facilities from 24 low- and lower-middle-income countries.

Methods

Selected data points from the World Health Organization’s (WHO) tool of situational analysis of surgical availability were extracted from the WHO’s database in December, 2013. These included infrastructure, physical resources and supplies, interventions, and human resources. For a descriptive analysis, facilities were divided into two groups based on number of beds (<100, 100–300, and >300) and level of facility (primary referral, secondary/tertiary, and Private/NGO/Mission). Statistical comparison was made between public and Private/NGO/Mission facilities based on number of beds (≤100, 100–300, and >300) using a Chi-Square analysis, with statistical significance at p < 0.05.

Findings

Significant deficiencies were noted in infrastructure, physical resources and supplies, and human resources for the provision of essential orthopedic surgical services at all tiers of the health system. Availability was significantly lower in public versus Private/NGO/Mission facilities for nearly all categories in facilities with ≤100 beds, and in a subset of measures in facilities with between 100 and 300 beds.

Interpretation

Deficiencies in the availability of orthopedic surgical services were observed at all levels of health facility and were most pronounced at facilities with ≤100 beds in the public sector. Strengthening the delivery of essential surgical services, including orthopedics, at the primary referral level must be prioritized if we are to reduce the burden of death and disability from a variety of emergent health conditions.

Funding

There were no sources of funding.

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Acknowledgments

We acknowledge all those representatives from the World Health Organization and the Ministries of Health in these 24 countries who contributed to collecting and submitting the data reported in this study.

Conflict of interest

The authors include WHO staff, and the views expressed in this publication reflect their views and not necessarily that of WHO. One of the authors (DS) has served as a consultant for the WHO.

Author information

Affiliations

  1. Division of Orthopaedic Surgery, Children’s Hospital of Philadelphia, 2nd Floor Wood Building, 34th Street and Civic Center Blvd, Philadelphia, PA, 19106, USA

    D. A. Spiegel & A. Nduaguba

  2. Harvard University School of Medicine, Boston, MA, USA

    A. Nduaguba

  3. Emergency and Essential Surgical Care (EESC) Program, Service Delivery and Safety Department (SDS), Health Systems and Innovation, World Health Organization- HQ, Avenue Appia 20, 1211, Geneva 27, Switzerland

    M. N. Cherian

  4. Service Delivery and Safety Department, World Health Organization-HQ, Avenue Appia 20, 1211, Geneva 27, Switzerland

    E. T. Kelley

  5. World Health Organization -Regional Office for Africa, Cité du Djoué, P.O. Box 06, Brazzaville, Republic of Congo

    M. Monono

Authors
  1. D. A. Spiegel
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  2. A. Nduaguba
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  3. M. N. Cherian
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  4. M. Monono
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  5. E. T. Kelley
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Corresponding author

Correspondence to D. A. Spiegel.

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Spiegel, D.A., Nduaguba, A., Cherian, M.N. et al. Deficiencies in the Availability of Essential Musculoskeletal Surgical Services at 883 Health Facilities in 24 Low- and Lower-Middle-Income Countries. World J Surg 39, 1421–1432 (2015). https://doi.org/10.1007/s00268-015-2971-2

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  • DOI: https://doi.org/10.1007/s00268-015-2971-2

Keywords

  • Health Facility
  • Septic Arthritis
  • Clubfoot
  • Joint Dislocation
  • Sterile Glove