If more members can be drawn into the group, particularly policy makers from ministries, then slowly the concept can infiltrate into major policies, and changes in health financing can be achieved in an attempt to improve access to surgical services among the underprivileged population particularly at the district hospital level.
– N. Mbembati
Get Involved
There are many ways to get involved in advocating for increasing access to surgical services, training, and research around the world. Members of the BESG are actively engaged in a wide range of surgery related initiatives throughout sub-Saharan Africa. Group members have knowledge and experience in integrating surgery at the district level, trauma system development, surgical training strategies and research.
If you are interested in getting involved in a specific area or in a particular country, please contact us and we may be able to link you to one of the BESG members or affiliated organizations.
Trauma System Development
Trauma accounts for a significant proportion of the injury burden in sub-Saharan Africa and available evidence suggests that the situation will only worsen in the foreseeable future. By the year 2020, initial projections were that injury will account for 20% of the global burden of disease, with road traffic injuries representing the third leading cause of lost DALYs. Africa has the highest road traffic injury mortality rate in the world at 28/100,000 people, and has 50 deaths/10,000 vehicles compared to 1.7 deaths/10,000 vehicles in high-income countries. In spite of these trends, little attention has been paid to the prevention and treatment of injury by governments and donors.
The BESG has begun to review trauma programs around the world and particularly in Africa, and outline some model approaches to building and maintaining effective trauma care systems.
Strengthening surgery at district hospitals
Despite the high burden of disease associated with surgical conditions in Africa, access to essential and life-saving surgery is limited outside specialized referral hospitals. Obstacles to access include shortage of trained staff, poor basic infrastructure, inadequate supplies of drugs and essential equipment, poor working conditions and low staff morale, lack of communication and referral facilities, cost of treatment to patients, and poor management. While there is need for general upgrading of many district hospitals, the existence of an appropriately equipped operating room and the availability of adequately trained surgical health personnel would benefit women with life-threatening obstetric complications and obstructed labor, and patients needing other surgical procedures.
The BESG has begun to review effective provision of surgery at first referral hospitals around the world and particularly in Africa, and outline some model approaches to strengthening and integrating surgery at this facility level to include components such as: population needs, determinants, and access; prevention; health system context; equipment and drugs; human resources and supervision; referral, transportation, and pre-hospital care; health information system/records; costs; outcomes; evaluation; policy and dissemination.
Training Strategies to increase surgical capacity
There is an estimated shortage of one million healthcare workers in sub-Saharan Africa. This shortage is partly because not enough people are appropriately trained but is compounded by meager salaries, poor working conditions, low morale, inadequate remuneration, few opportunities for continuous professional development, and for those working in rural areas, there is professional isolation, inadequate communication with peers and consultants in the cities, and lack of books, equipment and technologies. Surgeons are in extremely short supply and are in fact decreasing in number partly because young doctors prefer to specialize in an area that could lead to their employment by international agencies. One solution, at least in the short term, is to train non-doctors to provide some surgical services at the district level.
The BESG has begun to review innovative strategies to increase capacity to provide surgical services, around the world and particularly in Africa, and outline some model approaches to training, for example: training of surgeons in supervision; on-the-job training of physicians, and training of non-physicians such as assistant medical officers, clinical officers and nurses in basic surgery.
Building the evidence base for essential surgery
There has been few population studies of the prevalence or incidence of surgical conditions, and of the existing studies, most have been conducted within hospitals. Very little is known about unmet need for surgical services, obstacles to access or the impact of interventions. The use of cost-effectiveness to evaluate interventions is also rare. There is need for further research in following areas: burden of surgically treatable or avertable conditions, and unmet need; equity in access, patterns of seeking care, barriers, cost; quality: diagnostic accuracy, outcomes, supervision, patient satisfaction, public trust; current spending: private and public, cost-effectiveness of essential surgical package; human resources: quantity, who does what, where, training programs, policy options; other resource requirements for scaling-up services: supplies, equipment, drugs, infrastructure.
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