Sub-Saharan Africa has one of the highest burdens of surgically treatable conditions in the world and the highest unmet need, especially in rural areas. Zambia is one of the countries in the region taking steps to improve surgical care for its rural populations.
To demonstrate changes in surgical capacity in Zambia’s district hospitals over a 3-year period and to provide a baseline from which future interventions in surgical care can be assessed.
A cross-sectional assessment of surgical capacity, using a modified WHO questionnaire, was administered in first-level hospitals in nine of Zambia’s ten provinces between November 2012 and February 2013 and again between February and April 2016. The two assessments allowed measurement of changes in surgical workforce, infrastructure, equipment, drugs and consumables; and numbers of major surgical procedures performed over two 12-month periods prior to the assessments.
There was a significant increase, 2013–2016, in number of theatre staff, from 174 (mean 4.4; SD 1.7) to 235 (mean 6; SD 2.9), P = 0.02. However, the percentage of hospitals with functioning anaesthetic machines dropped from 64 to 41%. There was also a drop in hospitals reporting availability of instruments, drugs and consumables from 38 to 24 (97–62%) and from 28 to 24 (72–62%), respectively. The median number of caesarean sections in 2012 was 99 [interquartile range (IQR) 42–187] and 100 (IQR 42–126) in 2015 (P value =0.53). The median number of major surgical procedures in 2012 was 54 (IQR 10–113) and 66 (IQR 18–168) in 2015 (P = 0.45).
An increase in the first-level hospital surgical workforce between 2013 and 2016 was accompanied by reductions in essential equipment and consumables for surgery, and no changes in surgical output. Periodic monitoring of resource availability is needed to address shortages and make safe surgery available to rural populations.
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Luboga S, Macfarlane SB, Von Schreeb J, Kruk ME, Cherian MN, Bergström S et al (2009) Increasing access to surgical services in Sub-Saharan Africa: Priorities for national and international agencies recommended by the Bellagio essential surgery group. PLoS Med 6:1–5
World Health Organisation. WHO global initiative for emergency and essential surgical care sixth biennial and tenth anniversary meeting. 2015;
Shrime MG, Dare A, Alkire BC, Meara JG (2016) A global country-level comparison of the financial burden of surgery. Br J Surg 103(11):1453–1461
Mock CN, Donkor P, Gawande A, Jamison DT, Kruk ME, Debas HT (2015) Essential surgery: key messages from Disease Control Priorities, 3rd edition. Lancet 385(9983):2209–2219
Shrime MG, Bickler SW, Alkire BC, Mock C (2015) Global burden of surgical disease: an estimation from the provider perspective. Lancet Glob Health 3(S2):S8–S9
Citron I, Chokotho L, Lavy C (2016) Prioritisation of Surgery in the National Health Strategic Plans of Africa: a systematic review. World J Surg 40(4):779–783. https://doi.org/10.1007/s00268-015-3333-9
Meara JG, Leather AJM, Hagander L, Alkire BC, Alonso N, Ameh EA et al (2015) Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet 386(9993):569–624
Horton S, Alderman H, Rivera JA. Copenhagen Consensus 2008. 2008;1–40
Osen H, Chang D, Choo S, Perry H, Hesse A, Abantanga F et al (2011) Validation of the world health organization tool for situational analysis to assess emergency and essential surgical care at district hospitals in Ghana. World J Surg 35(3):500–504. https://doi.org/10.1007/s00268-010-0918-1
Henry JA, Frenkel E, Borgstein E, Mkandawire N, Goddia C (2015) Surgical and anaesthetic capacity of hospitals in Malawi: key insights. Health Policy Plan 30(8):985–994
Henry JA, Windapo O, Kushner AL, Groen RS, Nwomeh BC (2012) A survey of surgical capacity in rural southern Nigeria: opportunities for change. World J Surg 36(12):2811–2818. https://doi.org/10.1007/s00268-012-1764-0
Markin A, Barbero R, Leow JJ, Groen RS, Perlman G, Habermann EB et al (2014) Inter-rater reliability of the PIPES tool: validation of a surgical capacity index for use in resource-limited settings. World J Surg 38(9):2195–2199. https://doi.org/10.1007/s00268-014-2522-2
Carlson LC, Lin JA, Ameh EA, Mulwafu W, Donkor P, Derbew M et al (2015) Moving from data collection to application: a systematic literature review of surgical capacity assessments and their applications. World J Surg 39(4):813–821. https://doi.org/10.1007/s00268-014-2938-8
MOH. The 2012 List of Health Facilities in Zambia Preliminary Report. 2013;(15)
CSO. Zambia 2010 census of population and housing: National analytical report. 2012
Esquivel MM, Uribe-Leitz T, Makasa E, Lishimpi K, Mwaba P, Bowman K et al (2016) Mapping Disparities in access to safe, timely, and essential surgical care in Zambia. JAMA Surg 151(11):1064
Republic of Zambia Ministry of Health. National Health Strategic Plan 2011–2015. 2011;1–99
Gajewski J, Dharamshi R, Strader M, Kachimba J, Borgstein E, Mwapasa G et al (2017) Who accesses surgery at district level in sub-Saharan Africa? Evidence from Malawi and Zambia. Trop Med Int Health 22(12):1533–1541
Bowman KG, Jovic G, Rangel S, Berry WR, Gawande AA (2013) Pediatric emergency and essential surgical care in Zambian hospitals: a nationwide study. J Pediatr Surg. 48(6):1363–1370
Kamwanga J, Koyi G, Mwila J, Musonda M BR. Understanding the labour market of human resources for health in Zambia. WHO [Internet]. 2013;(November):23. http://www.who.int/hrh/tools/Sudan%7B_%7Dfinal.pdf
Ferrinho P, Siziya S, Goma F, Dussault G (2011) The human resource for health situation in Zambia: deficit and maldistribution. Hum Resour Health 9(1):30
Gajewski J, Mweemba C, Cheelo M, McCauley T, Kachimba J, Borgstein E et al (2017) Non-physician clinicians in rural Africa: lessons from the medical licentiate programme in Zambia. Hum Resour Health 15(1):53
Health MOF. Republic of Zambia Ministry of Health National Surgical, Obstetric, and Anaesthesia Strategic Plan (Nsoasp) year 2017–2021. 2017
Gajewski J, Conroy R, Bijlmakers L, Mwapasa G, McCauley T, Borgstein E et al (2018) Quality of surgery in Malawi: comparison of patient-reported outcomes after hernia surgery between district and central hospitals. World J Surg 42(6):1610–1616. https://doi.org/10.1007/s00268-017-4385-9
Technologies H. Tool for situational analysis to assess emergency and essential surgical care
Chu K, Rosseel P, Gielis P, Ford N, Schrecker T (2009) Surgical task shifting in Sub-Saharan Africa. PLoS Med 6(5):e1000078. https://doi.org/10.1371/journal.pmed.1000078
Mullan F, Frehywot S (2007) Non-physician clinicians in 47 sub-Saharan African countries. Lancet 370(9605):2158–2163
O’Neill K, Takane M, Sheffel A, Abou-Zahr C, Boerma T (2013) Monitoring service delivery for universal health coverage: the Service Availability and Readiness Assessment. Bull World Health Organ 91(12):923–931
Dubowitz G, Detlefs S, Mcqueen KAK (2010) Global anesthesia workforce crisis : a preliminary survey revealing shortages contributing to undesirable outcomes and unsafe practices. World J Surg 34(3):438–444. https://doi.org/10.1007/s00268-009-0229-6
Kushner AL (2010) Addressing the millennium development goals from a surgical perspective. Arch Surg 145(2):154
Mock C (2015) Surgical capacity surveys: a call for papers on the next steps for moving beyond descriptive data. World J Surg 39(4):811–812. https://doi.org/10.1007/s00268-015-2983-y
Greenleaf AR, Gibson DG, Khattar C, Labrique AB, Pariyo GW. Building the evidence base for remote data collection in low- and middle-income countries: comparing reliability and accuracy across survey modalities. Rosskam E, Hyder A, editors. vol. 19, Journal of Medical Internet Research. 2017
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Cheelo, M., Brugha, R., Bijlmakers, L. et al. Surgical Capacity at District Hospitals in Zambia: From 2012 to 2016. World J Surg 42, 3508–3513 (2018). https://doi.org/10.1007/s00268-018-4678-7