K. Garringer1, O. Ahearn1, J. Incorvia1, L. Drown1, K. Iverson1,3, D. Burssa2, S. Esseye2,6, V. Smith4, J. Meara1,5, A. Beyene1,7, A. Bekele1,7, S. Bari1 1Harvard School Of Medicine,Program In Global Surgery And Social Change,Brookline, MA, USA 2Federal Ministry of Health, Ethiopia,Addis Ababa, ADDIS ABABA, Ethiopia 3University Of California – Davis,Department Of Surgery,Sacramento, CA, USA 4Assist International,Safe Surgery 2020,Ripon, CA, USA 5Children’s Hospital Boston,Department Of Pediatric Plastic And Oral Surgery,Boston, MA, USA 6Jhpiego,Safe Surgery 2020,Addis Ababa, ADDIS ABABA, Ethiopia 7Addis Ababa University,School Of Medicine, Department Of Surgery,Addis Ababa, ADDIS ABABA, Ethiopia
Introduction: In Ethiopia, the Safe Surgery 2020 initiative is a collaborative effort of partner organizations that implement innovative programs to improve the surgical system. This initiative directly supports the Federal Ministry of Health’s national surgical planning effort that aims to improve access to surgical and anesthesia care in hospitals at all levels of the health system.
Surgical referrals are common within health systems in low- and middle-income countries, where high-quality surgical services are often only available at referral and specialized hospitals located in urban areas. It is important to understand the specific reasons for referrals that are being made for surgical services. This will lend insight to gaps in surgical care and will serve to strengthen primary hospital capacity and reduce the referral burden on higher level hospitals. This study intended to determine the most common reasons for referrals from primary-level hospitals to general and specialized-level hospitals in the Amhara region of Ethiopia.
Methods: Data on surgical referrals and specific reasons for referral were recorded by surgical team members using newly designed and implemented clinical registries at five primary-level hospitals in the Amhara region of Ethiopia. A descriptive, cross-sectional study was conducted by reviewing the reasons for all emergency and elective surgical referrals that were made to higher-level hospitals during the month of May 2018.
Results: A total of 327 surgical referrals were recorded in the month of May among five primary-level hospitals included in this study (Table 1). The monthly median number of referrals was 70 referrals (IQR 65 – 70). The majority of the referrals (89.9%) were attributed to a ‘lack of specialist care’ at the referring hospitals. The next most common reasons for referral were: a ‘lack of diagnostic equipment’ (3.1%), a ‘lack of drugs’ (1.8%) and ‘patient preference’ (1.8%).
Conclusion: There is a substantial need for specialized surgical care in the Amhara region of Ethiopia, as there is a limited capacity to perform advanced surgical procedures in primary-level hospitals. This finding reiterates the importance of increasing the specialist surgical workforce in Ethiopia, in line with recommendations made by the Lancet Commission on Global Surgery in 2015. A lack of necessary equipment, supplies, and resources in these hospitals also leads to referrals. Results indicate that further consideration of referral reasons among hospitals throughout the country could help to identify focus areas for Safe Surgery 2020 programs and future Ministry of Health interventions meant to increase surgical capacity at the primary-hospital level.
