Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, Boston, Massachusetts, United States of America.
Department of Surgery, Massachusetts General Hospital (MGH), Boston, Massachusetts, United States of America.
PLoS One. 2018 Apr 17;13(4):e0195986. doi: 10.1371/journal.pone.0195986. eCollection 2018.
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.
From September to November 2016, we conducted a mixed-methods countrywide surgical capacity assessment at 17 randomly selected public hospitals in Uganda. 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.
The Ugandan public health care 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. Hospital staff 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 to provide surgical care to those most in need.
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.
全球有 50 亿人无法获得安全、负担得起且及时的外科手术和麻醉护理。在资源匮乏的环境中提供外科护理仍然面临着重大挑战。乌干达也不例外。
2016 年 9 月至 11 月，我们在乌干达 17 家随机选定的公立医院进行了一项混合方法的全国外科能力评估。研究人员对 35 名利益攸关方进行了 35 次半结构化访谈，以了解与提供外科护理相关的因素。使用框架方法进行主题和解释性数据分析。
乌干达公共医疗保健部门在提供安全、及时和负担得起的外科护理方面继续面临重大挑战。这些挑战可以大致分为准备和政策、服务提供以及外科护理的财务负担。医院工作人员报告了以下挑战：（1）由于转诊系统出现故障，获得外科护理的时间严重延迟；（2）工作人员严重短缺；（3）手术能力因基础设施不足和紧急情况及产科量过大而受到限制；（4）提供基本药物、设备、用品和血液方面存在供应链困难；（5）外科患者及其家属的费用巨大、多变且有时是灾难性的；（6）缺乏针对手术的政策和重点。尽管存在这些挑战，但公共部门正在采用创新战略为最需要的人提供外科护理。
提供外科护理的障碍具有跨领域性，涉及基础设施、服务提供、劳动力和融资方面的限制。了解乌干达外科系统当前的优势和不足是制定有效、有针对性的政策和规划以建立和加强其外科能力的关键第一步。
