status of surgical activity in sierra leone in 2012 results from a country wide survey håkon a....
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Status of surgical activity in Sierra Leone in 2012
Results from a country wide survey
Håkon A. Bolkan
Chairman – CapaCare
19. June 2014
Baseline study - Aim
1. Establish a baseline for surgical and obstetrical activity in Sierra Leone in 2012
2. Comprehensive mapping of nationwide major surgical activity
3. Identify training resources (Hosp/organisations)
Bolkan, et al - Submitted 2014
Facilities performing one or more of the comprehensive surgical procedures listed in
the WHO used Service and Readiness Assessment (SARA) tool.
Methodology - selection of institutions (1)
Methodology - process
• Data collection January – May 2013• Medical students• Source of data
– Operation Theatre Logbooks– Delivery log books– Anesthesia log books
Duplicates removed
Major surgeries/100 000 population
Weste
rn A
rea
Port Lo
ko
Bombali Bo
TonkoliliKono
Kenema
Kailahun
Koinadugu
Pujehun
Bonthe
Kambia
Moyamba
0
100
200
300
400
500
600
700
800
900
1000
National average
X 30
Surgical HR - Who
35%
53%
4% 8%
Distribution of surgical providers
ConsultantMedical DoctorNurseAssociate Clinician
Consultant Medical Doctor Nurse Associate Clinician Total
n % n % n % n % n %
58,5 35,4 % 87,0 52,6 % 6,2 3,7 % 13,8 8,3 % 165,4
HR – FTE per provider and sector
Distribution of surgical providers
Consultant Medical Doctor Nurse Associate Clinician Total
n % n % n % n % n %
Governmental 21,3 36,3 % 50,1 57,6 % 2,0 32,4 % 3,0 21,8 % 76,3 46,2 %
Private For Profit 12,8 21,9 % 4,3 5,0 % 0,1 1,4 % 3,0 21,8 % 20,2 12,2 %
Private Non Profit 24,4 41,7 % 32,6 37,5 % 4,1 66,2 % 7,8 56,4 % 68,8 41,6 %
Total 58,5 35,4 % 87,0 52,6 % 6,2 3,7 % 13,8 8,3 % 165,4
Consultant Medical Doctor Nurse Associate Clinician0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Private Non ProfitPrivate For ProfitGovernmental
HR – Surgical activity by healthcare provider and sector
Distribution of surgical providers
Associate Clin-ician
Consultant Obstetrician
Consultant Surgeon
Medical Doctor
Nurse Unknown0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
Private Non ProfitPrivate For ProfitGovernmental
HR – Surgical activity by healthcare provider nationality and sector
Distribution of surgical providers
Associa
te Clin
ician
Consulta
nt Obste
tricia
n
Consulta
nt Surg
eon
Medica
l Docto
rNurse
Unknown0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
UnknownForeignDomestic
Distribution of surgical providers
Bo
Bombali
Kailahun
Kambia
Kenema
KoinaduguKono
Moyamba
Port Lo
ko
Pujehun
Tonkolili
Weste
rn A
rea
0
1
2
3
4
5
6
7
8
9
Accumulate surgical provider density by 100 000 population
Associate Clinician
Nurse
Medical Doctor
Consultant
Bo
Bombali
Bonthe
Kailahun
Kambia
Kenema
KoinaduguKono
Moyamba
Port Lo
ko
Pujehun
Tonkolili
Weste
rn A
rea
0
100
200
300
400
500
600
700
800
900
1000
Major surgical procedures by 100 000 population
Conclusion
1. Large unmet need for major surgery in Sierra Leone
2. Large discrepancies between urban and rural areas
3. Physician constrains in District hospitals
4. Private Non Profit is a major surgical service provider
5. Surgery and obstetrics – developed as one service
Aim: Increase surgical capacity and activity in Sierra Leone
2011 2013 2014 2015 20162012 2017
Training program
Baseline study - Nationwide
Service provision
Goal: 30
Goal: 100% increase
MonitoringQuality DH
Training Housemanship