K. Albutt1,2, R. R. Yorlets2, M. Punchak2,3, P. Kayima4, D. B. Namanya5,6, G. A. Anderson1,2, M. G. Shrime2,7 1Massachusetts General Hospital,Department Of Surgery,Boston, MA, USA 2Harvard Medical School,Program In Global Surgery And Social Change,Boston, MA, USA 3David Geffen School Of Medicine, University Of California At Los Angeles,Los Angeles, CA, USA 4Mbarara University Of Science And Technology,Department Of Surgery,Mbarara, MBARARA, Uganda 5Ministry Of Health,Planning Division,Kampala, KAMPALA, Uganda 6Uganda Martyrs University,Nkozi, NKOZI, Uganda 7Massachusetts Eye And Ear Infirmary,Department Of Otolaryngology,Boston, MA, USA
Introduction: Five billion people lack access to safe, affordable, and timely surgical and anesthesia care. Significant challenges remain in the provision of surgical care in low-resource settings. Uganda is no exception.
Methods: From September to November 2016, we conducted a mixed-methods countrywide surgical capacity assessment at 17 randomly selected public hospitals in Uganda (Figure 1). Researchers conducted 35 semi-structured interviews with key stakeholders to understand factors related to the provision of surgical care. The framework approach was used for thematic and explanatory data analysis.
Results: The Ugandan public sector continues to face significant challenges in the provision of safe, timely, and affordable surgical care. These challenges can be broadly grouped into preparedness and policy, service delivery, and the financial burden of surgical care. Providers reported challenges including: (1) significant delays in accessing surgical care, compounded by a malfunctioning referral system; (2) critical workforce shortages; (3) operative capacity that is limited by inadequate infrastructure and overwhelmed by emergency and obstetric volume; (4) supply chain difficulties pertaining to provision of essential medications, equipment, supplies, and blood; (5) significant, variable, and sometimes catastrophic expenditures for surgical patients and their families; and (6) a lack of surgery-specific policies and priorities. Despite these challenges, innovative strategies are being used in the public sector to provide surgical care to those most in need.
Conclusion: Barriers to the provision of surgical care are cross-cutting and involve constraints in infrastructure, service delivery, workforce, and financing. Understanding current strengths and shortfalls of Uganda’s surgical system is a critical first step in developing effective, targeted policy and programming that will build and strengthen its surgical capacity. The public sector, as the provider of care for the majority as well as the most impoverished, must champion the surgical agenda in Uganda. Further research is warranted to better understand the impact of surgical capacity building interventions as they are undertaken in LMICs.
