The neglect of the global surgical workforce: experience and evidence from Uganda.
Doruk Ozgediz,Moses Galukande,Jacqueline Mabweijano,Stephen Kijjambu,Cephas Mijumbi,Gerald Dubowitz,Samuel Kaggwa,Samuel Luboga +7 more
Reads0
Chats0
TLDR
The first comprehensive analysis of the surgical workforce in Uganda is reported, identifying challenges to workforce development, and evaluating current programs addressing these challenges.Abstract:
Africa’s health workforce crisis has recently been emphasized by major international organizations. As a part of this discussion, it has become apparent that the workforce required to deliver surgical services has been significantly neglected. This paper reviews some of the reasons for this relative neglect and emphasizes its importance to health systems and public health. We report the first comprehensive analysis of the surgical workforce in Uganda, identify challenges to workforce development, and evaluate current programs addressing these challenges. This was performed through a literature review, analysis of existing policies to improve surgical access, and pilot retrospective studies of surgical output and workforce in nine rural hospitals. Uganda has a shortage of surgical personnel in comparison to higher income countries, but the precise gap is unknown. The most significant challenges to workforce development include recruitment, training, retention, and infrastructure for service delivery. Curricular innovations, international collaborations, and development of research capacity are some of the initiatives underway to overcome these challenges. Several programs and policies are addressing the maldistribution of the surgical workforce in urban areas. These programs include surgical camps, specialist outreach, and decentralization of surgical services. Each has the advantage of improving access to care, but sustainability has been an issue for all of these programs. Initial results from nine hospitals show that surgical output is similar to previous studies and lags far behind estimates in higher-income countries. Task-shifting to non-physician surgical personnel is one possible future alternative. The experience of Uganda is representative of other low-income countries and may provide valuable lessons. Greater attention must be paid to this critical aspect of the global crisis in human resources for health.read more
Citations
More filters
Journal ArticleDOI
Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development
John G. Meara,John G. Meara,Andrew J M Leather,Lars Hagander,Blake C. Alkire,Nivaldo Alonso,Emmanuel A. Ameh,Stephen W. Bickler,Lesong Conteh,Anna J Dare,Justine Davies,Eunice D érivois Mérisier,Shenaaz El-Halabi,Paul Farmer,Paul Farmer,Atul A. Gawande,Rowan Gillies,Sarah L M Greenberg,Sarah L M Greenberg,Sarah L M Greenberg,Caris E Grimes,Russell L. Gruen,Russell L. Gruen,Edna Adan Ismail,Thaim B. Kamara,Chris Lavy,Ganbold Lundeg,Nyengo Mkandawire,Nyengo Mkandawire,Nakul P Raykar,Nakul P Raykar,Nakul P Raykar,Johanna N Riesel,Edgar B. Rodas,John A. Rose,Nobhojit Roy,Mark G. Shrime,Mark G. Shrime,Richard Sullivan,Stéphane Verguet,David A. K. Watters,Thomas G. Weiser,Iain H Wilson,Gavin Yamey,Winnie Yip +44 more
TL;DR: The need for surgical services in low- and middleincome countries will continue to rise substantially from now until 2030, with a large projected increase in the incidence of cancer, road traffic injuries, and cardiovascular and metabolic diseases in LMICs.
Journal ArticleDOI
Global disease burden of conditions requiring emergency surgery
Barclay T. Stewart,P. Khanduri,C. McCord,M. Ohene-Yeboah,Selman Uranues,F. Vega Rivera,Charles Mock +6 more
TL;DR: Surgical disease is inadequately addressed globally, and emergency conditions requiring surgery contribute substantially to the global disease burden.
Journal ArticleDOI
Global operating theatre distribution and pulse oximetry supply: an estimation from reported data
Luke M. Funk,Luke M. Funk,Thomas G. Weiser,Thomas G. Weiser,William R. Berry,William R. Berry,Stuart R. Lipsitz,Alan Merry,Angela Enright,Iain H. Wilson,Gerald Dziekan,Atul A. Gawande,Atul A. Gawande +12 more
TL;DR: The global distribution of operating theatres and the availability of pulse oximetry were estimated and quantified and it was suggested that around 77,700 theatres worldwide were not equipped with pulse oximeters.
Journal ArticleDOI
Quantifying Surgical Capacity in Sierra Leone: A Guide for Improving Surgical Care
T. Peter Kingham,Thaim B. Kamara,Meena Cherian,Richard A. Gosselin,Meghan Simkins,Chris Meissner,Lynda Foray-Rahall,Kisito S. Daoh,Soccoh A. Kabia,Adam L. Kushner +9 more
TL;DR: There are severe shortages in all aspects of infrastructure, personnel, and supplies required for delivering surgical care in Sierra Leone, and training additional personnel to deliver safe surgical care is possible.
Journal ArticleDOI
Shortage of doctors, shortage of data: a review of the global surgery, obstetrics, and anesthesia workforce literature.
Marguerite Hoyler,Marguerite Hoyler,Samuel R.G. Finlayson,Craig D. McClain,Craig D. McClain,John G. Meara,John G. Meara,Lars Hagander,Lars Hagander +8 more
TL;DR: There is a critical need for systematically collected, national-level data regarding surgery providers in LMICs to guide improvements in surgery access and care, and ongoing initiatives to supplement the existing surgical workforce data are described.
References
More filters
Journal Article
The Challenge of Global Health
TL;DR: A recent extraordinary and unprecedented rise in public and private giving more money is being directed toward pressing heath challenges than ever before, but because the efforts this money is paying for are largely uncoordinated and directed mostly at specific high-profile diseases, there is a grave danger that the current age of generosity could not only fall short of expectations but actually make things worse on the ground as discussed by the authors.
Journal ArticleDOI
Anaesthesia services in developing countries: defining the problems
TL;DR: The use of a questionnaire to define the difficulties in providing anaesthesia in Uganda showed that 23% of anaesthetists have the facilities to deliver safe anaesthesia to an adult, 13% to delivery safe anaesthetic to a child and 6% to deliversafe anaesthesia for a Caesarean section.
Journal ArticleDOI
Advancement of global health: key messages from the Disease Control Priorities Project
Ramanan Laxminarayan,Anne Mills,Joel G. Breman,Anthony R. Measham,George Alleyne,Mariam Claeson,Prabhat Jha,Philip Musgrove,Jeffrey Chow,Sonbol A. Shahid-Salles,Sonbol A. Shahid-Salles,Dean T. Jamison +11 more
TL;DR: A major product of DCPP, Disease Control Priorities in Developing Countries, 2nd edition (DCP2), focuses on the assessment of the cost-effectiveness of health-improving strategies (or interventions) for the conditions responsible for the greatest burden of disease.
Journal ArticleDOI
Children and armed conflict in the Democratic Republic of the Congo.
Freedson J,Singh S +1 more
TL;DR: A 17-year-old boy was arrested by a Mai-Mai officer after he refused to draw water for the military stationed there and was severely tortured while he was held in detention in the camp as discussed by the authors.