Department of Surgery, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
S Afr Med J. 2013 Jul 29;104(1):57-60. doi: 10.7196/samj.7252.
The Department of Health in KwaZulu-Natal (KZN) has run a surgical outreach programme for over a decade.Objective. To quantify the impact of the outreach programme by analysing its effect on the operative capacity of a single rural health district.
During 2012, investigators visited each district hospital in Sisonke Health District (SHD), KZN to quantify surgery undertaken by resident staff between 1998 and 2013. Investigators also reviewed the operative registers of the four district hospitals in SHD for a 6-month period (March - August 2012) to document the surgery performed at each hospital. The number of staff who attended specialist-based teaching was recorded in an attempt to measure the impact of each visit.
From 1998 to 2013, 35 385 patients were seen at 1 453 clinics, 5 199 operations were performed and 1 357 patients were referred to regional hospitals. A total of 3 027 staff attended teaching ward rounds and teaching sessions. In the four district hospitals, 2 160 operations were performed in the 6-month period. There were 653 non-obstetrical operations and the obstetric cases comprised 1 094 caesarean sections, 55 sterilisations and 370 evacuations of the uterus.
The infrastructure is well established and the outreach programme is well run and reliable. The clinical outputs of the programme are significant. However, the impact of this programme on specific outcomes is less certain. This raises the question of the future strategic choices that need to be made in our attempts to improve access to surgical care.
夸祖鲁-纳塔尔省（KZN）卫生部开展了一项外科推广计划已有十多年。
通过分析该推广计划对一个农村卫生区手术能力的影响，量化其效果。
在 2012 年期间，调查员访问了夸祖鲁-纳塔尔省 Sisonke 卫生区（SHD）的每所地区医院，以量化 1998 年至 2013 年期间驻地工作人员所进行的手术。调查员还查看了 SHD 区 4 所地区医院的手术登记册，记录 2012 年 3 月至 8 月期间各医院开展的手术。记录参加以专科为基础的教学的工作人员人数，试图衡量每次访问的影响。
1998 年至 2013 年，共有 35385 名患者在 1453 个诊所就诊，5199 例手术，1357 例患者转至区域医院。共有 3027 名工作人员参加教学查房和教学课程。在这 4 所地区医院，在 6 个月期间进行了 2160 例手术。非产科手术有 653 例，产科病例包括 1094 例剖宫产、55 例绝育和 370 例子宫排空。
基础设施完善，推广计划运作良好且可靠。该计划的临床成果显著。然而，该计划对特定结果的影响尚不确定。这就提出了一个问题，即在我们努力改善获得外科护理的机会时，需要做出哪些未来的战略选择。
