N. T. Kontchou1,2, K. Schulman1,3 1Harvard Business School,Boston, MA, USA 2Harvard School Of Medicine,Brookline, MA, USA 3Duke University Medical Center,Durham, NC, USA
Introduction: With 23·4 million inhabitants, Cameroon's rate of 1·5 health workers per 1,000 people falls short of the World Health Organization’s recommended minimum of 2·3 per 1,000. The country’s 1·2 surgical specialists per 100,000 people again does not meet the Lancet Commission of Global Surgery’s estimated minimum need of 20 surgical, anesthetic, and obstetric physicians per 100,000 people for effective, sustainable surgical care. Though alarmingly low, this figure is not uncommon in sub-Saharan Africa.
In 2005, cardiac surgeons from San Donato Policlinico in Milan, Italy partnered with religious leaders in Kumbo, Cameroon to construct Shisong Cardiac Center and address the surgical workforce shortage in the region. Now one of the primary cardiac surgery referral centers in Cenral Africa, Shisong Cardiac Center has only one local cardiac surgeon and still operates under a commuter care delivery model, relying heavily on foreign surgeons to deliver care to a vastly uninsured population with a GDP per capita of $1,250 USD. The pressure to build continuity of care, increase local workforce, secure sustainable financing sources, and fill the operating rooms are ever-present.
Methods: A literature review was performed to evaluate the global surgical disease burden, the epidemiology of disease in Cameroon, and the country’s healthcare system financing sources. Interviews were conducted with Cameroon's Minister of Health, local World Bank Health Specialists, founders of Shisong Cardiac Center, the center’s chief executive officer, and its cardiac surgery providers. These interviews were audio-recorded and transcribed manually. An on-site visit of the hospital was completed to obtain key images.
Results: Since 2009, post-surgical mortality ranged from a high of 10.6% to 6.7% in 2014-15, with the most recent mortality rate of 7.1% for 2015-16. Since 2009, only 5 out of 610 (0.82%) patients required reoperation, but this number does not capture those who died prior to reoperation or who were unable to afford a second surgery. With a fixed price of $4,750 per cardiac surgery and 80% of patients lacking funding, Shisong loses over $3,000 with every pediatric surgery. These external constraints restrict the hospital to one hundred operations a year, or less than twenty percent of its full capacity. Despite these challenges, the hospital still achieved a positive margin of $19,000 in the 2015-2016 fiscal year.
Conclusion: The solidarity, goodwill, and humanitarian values upon which Shisong Cardiac Center was founded have sustained this initiative for almost a decade. However, the intensity of care required to treat cardiac disease surgically, patients’ insufficient financial means, difficult access by road, limited governmental financial support, and Shisong’s inadequate access to essential specialty physicians make sustaining this innovative program a continuing challenge despite its success.