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Estimation of Surgery Capacity in Haiti: Nationwide Survey of Hospitals

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Abstract

Background

Haiti’s surgical capacity was significantly strained by the 2010 earthquake. As the government and its partners rebuild the health system, emergency and essential surgical care must be a priority.

Methods

A validated, facility-based assessment tool developed by WHO was completed by 45 hospitals nationwide. The hospitals were assessed for (1) infrastructure, (2) human resources, (3) surgical interventions and emergency care, and (4) material resources for resuscitation. Fisher’s exact test was used to compare hospitals by sectors: public compared to private and mixed (public–private partnerships).

Results

The 45 hospitals included first-referral level to the national referral hospital: 20 were public sector and 25 were private or mixed sector. Blood banks (33 % availability) and oxygen concentrators (58 %) were notable infrastructural deficits. For human resources, 69 % and 33 % of hospitals employed at least one full-time surgeon and anaesthesiologist, respectively. Ninety-eight percent of hospitals reported capacity to perform resuscitation. General and obstetrical surgical interventions were relatively more available, for example 93 % provided hernia repairs and 98 % provided cesarean sections. More specialized interventions were at a deficit: cataract surgery (27 %), cleft repairs (31 %), clubfoot (42 %), and open treatment of fractures (51 %).

Conclusion

Deficiencies in infrastructure and material resources were widespread and should be urgently addressed. Physician providers were mal-distributed relative to non-physician providers. Formal task-sharing to midlevel and general physician providers should be considered. The parity between public and private or mixed sector hospitals in availability of Ob/Gyn surgical interventions is evidence of concerted efforts to reduce maternal mortality. This ought to provide a roadmap for strengthening of surgical care capacity.

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Acknowledgments

The authors would like to thank the Medical Directors, Chief Administrators, attending surgeons, and statisticians who work tirelessly at all 45 hospitals. The authors are grateful for the support of officials and staff of the Government of Haiti Ministère de la Santé Publique et de la Population: Dr. Guirlaine Raymond (Director General), Dr. James Beaubrun (Director of Human Resources), Mr. Roody Thermidor (Unit for Planning and Evaluation); Mr. Mario Cyr (formerly of Pan American Health Organization Haiti Country Office) and Mr. Antoine Artiganave (formerly of Clinton Health Access Initiative). The authors have undertaken this research under the auspices of the State University of Haiti (UEH) and University of California Haiti Initiative, and thank Professor Jean-Vernet Henry (Rector of the UEH), and Dr. Thomas Coates (Director of the UCLA Center for World Health).

Conflict of interest

The authors declare no conflict of interest.

Disclaimer

The authors include WHO staff. The views in this publication reflect their views and not necessarily that of WHO.

Author information

Authors and Affiliations

  1. University of California Haiti Initiative, Los Angeles, CA, USA

    Tu M. Tran

  2. Hôpital de l’Université d’Etat d’Haïti, Rue Monseigneur Guilloux, Port-au-Prince, Haïti

    Mackenson Saint-Fort & Jacques B. Pierre Pierre

  3. Faculté de Médicine et des Sciences de la Santé, Université Notre Dame d’Haïti, Port-au-Prince, Haiti

    Marie-Djenane Jose & Jean Hugues Henrys

  4. Ministère de la Sante Publique et de la Population, Port-au-Prince, Haïti

    Jean Hugues Henrys

  5. Emergency & Essential Surgical Care Programme, Health Systems and Innovation, World Health Organization—HQ, Geneva, Switzerland

    Meena N. Cherian

  6. Institute for Global Orthopedics and Traumatology, University of California San Francisco, San Francisco, CA, USA

    Richard A. Gosselin

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  1. Tu M. Tran
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  2. Mackenson Saint-Fort
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  4. Jean Hugues Henrys
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  7. Richard A. Gosselin
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Corresponding author

Correspondence to Mackenson Saint-Fort.

Additional information

Tu M. Tran and Mackenson Saint-Fort are co-first authors.

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Tran, T.M., Saint-Fort, M., Jose, MD. et al. Estimation of Surgery Capacity in Haiti: Nationwide Survey of Hospitals. World J Surg 39, 2182–2190 (2015). https://doi.org/10.1007/s00268-015-3089-2

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