Department of Surgery, University of California Davis Medical Center, Sacramento, CA, USA; Department of Global Health and Social Medicine, Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.
Department of Global Health and Social Medicine, Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.
Int J Surg. 2020 Aug;80:231-240. doi: 10.1016/j.ijsu.2020.03.025. Epub 2020 Mar 19.
A baseline assessment of surgical capacity is recommended as a first-step to surgical system strengthening in order to inform national policy. In Ethiopia, the World Health Organization's Tool for Situational Analysis (WHO SAT) was adapted to assess surgical, obstetric, and anesthesia capacity as part of a national initiative: Saving Lives Through Safe Surgery (SaLTS). This study describes the process of adapting this tool and initial results.
The new tool was used to evaluate fourteen hospitals in the Southern Nations, Nationalities, and People's Region of Ethiopia between February and March 2017. Two analytic methods were employed. To compare this data to international metrics, the WHO Service Availability and Readiness Assessment (SARA) framework was used. To assess congruence with national policy, data was evaluated against Ethiopian SaLTS targets.
Facilities had on average 62% of SARA items necessary for both basic surgery and comprehensive surgery. Primary, general, and specialized facilities offered on average 84%, 100%, and 100% of SARA basic surgeries, and 58%, 73% and 90% of SARA comprehensive surgeries, respectively. An average of 68% of SaLTS primary surgeries were available at primary facilities, 83% at general facilities, and 100% at specialized facilities. General and specialized hospitals offered an average of 80% of SaLTS general surgeries, while one specialized hospital offered 38% of SaLTS specialized surgeries.
While the modified SaLTS Tool provided evaluation against Ethiopian national benchmarks, the resultant assessment was much lengthier than standard international tools. Analysis of results using the SARA framework allowed for comparison to global standards and provided insight into essential parts of the tool. An assessment tool for national surgical policy should maintain internationally comparable metrics and incorporation into existing surveys when possible, while including country-specific targets.
为了为国家政策提供信息，建议对手术能力进行基线评估，作为加强手术系统的第一步。在埃塞俄比亚，世界卫生组织的情况分析工具（WHO SAT）被改编用于评估外科、产科和麻醉能力，作为国家倡议“通过安全手术拯救生命（SaLTS）”的一部分。本研究描述了改编该工具的过程和初步结果。
新工具于 2017 年 2 月至 3 月在埃塞俄比亚南部地区的 14 家医院使用。采用了两种分析方法。为了将此数据与国际指标进行比较，使用了世卫组织服务可用性和准备情况评估（SARA）框架。为了评估与国家政策的一致性，根据埃塞俄比亚 SaLTS 目标评估数据。
各医疗机构平均有 62%的 SARA 项目是基本手术和综合手术所必需的。初级、普通和专科医院平均提供 84%、100%和 100%的 SARA 基本手术，以及 58%、73%和 90%的 SARA 综合手术。初级医疗机构平均可提供 68%的 SaLTS 初级手术，普通医疗机构可提供 83%，专科医院可提供 100%。普通和专科医院平均提供 80%的 SaLTS 普通手术，而一家专科医院提供 38%的 SaLTS 专科手术。
虽然经过修改的 SaLTS 工具提供了针对埃塞俄比亚国家基准的评估，但评估结果比标准国际工具长得多。使用 SARA 框架分析结果可以与全球标准进行比较，并深入了解工具的重要组成部分。国家外科政策评估工具应保持与国际可比的指标，并在可能的情况下纳入现有调查，同时纳入国家特定目标。
