K. Iverson1,2, I. Citron2, O. Ahearn2, K. Garringer2, S. Mukhodpadhyay2,7, D. Burssa5, A. Teshome5, A. Bekele5, S. Workneh5, M. Shrime2,4, J. Meara2,3 1University Of California – Davis,Sacramento, CA, USA 2Harvard School Of Medicine,Program In Global Surgery And Social Change,Boston, MA, USA 3Children’s Hospital Boston,Plastic Surgery,Boston, MA, USA 4Massachusetts Eye & Ear Infirmary,Boston, MA, USA 5Federal Ministry Of Health,Addis Ababa, AA, Ethiopia 7University Of Connecticut,Storrs, CT, USA
Introduction: As global surgery gains international attention, there is limited data in low- and middle-income countries on the capacity to provide surgical and anesthesia care. The objective of this study was to quantify the availability of surgical, obstetric, and anesthetic services in Ethiopian public hospitals.
Methods: A Harvard-WHO validated survey tool was adapted for the Ethiopian context, in collaboration with the Ethiopian Federal Ministry of Health. A total of 29 public hospitals were surveyed in three of eleven regions of Ethiopia, including 24 first-level, 3 second-level, and 2 third-level hospitals that self-reported performing surgery. The tool was administered in-person to senior administrators and surgical team members. 363 quantitative and qualitative questions were asked spanning eight categories: (1) General Information, (2) Infrastructure, (3) Surgical Sets, (4) Human Resources, (5) Interventions, (6) Emergency and Essential Surgical Care Equipment and Supplies, (7) Financing, and (8) Information Management. The answers were then validated with a hospital walkthrough and operative logbook review.
Results: All facilities surveyed performed surgical procedures despite the unreliability of basic infrastructure: 66% of facilities reported consistent running water, 55% had uninterrupted electricity, and 96% had a continuous oxygen supply. There were on average 0.87 fully-trained surgeons, anesthesiologists, and obstetricians per 100,000 population in the hospitals’ catchment areas (20-40 SAOs/100,000 recommended by the Lancet Commission on Global Surgery). This was supplemented by 4.08/100,000 non-specialist surgical or anesthesia providers. In first-level hospitals, 96% provided cesarean sections, 79% provided laparotomies, and 0% provided open fracture repairs. A lack of supplies was also a common theme at several first-level hospitals, with only 46% reporting consistent availability of needles and sutures and 71% local anesthesia.
Conclusion: Severe shortages exist in infrastructure, human resources, and emergency and essential surgical supplies in the Ethiopian facilities surveyed. These deficits limit procedures provided by these hospitals, particularly orthopedic surgery. The data from this study can inform future interventions designed to strengthen the Ethiopian surgical system.