Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
S Afr Med J. 2021 Mar 31;111(4):343-349. doi: 10.7196/SAMJ.2021.v111i4.15281.
The role of the district hospital (DH) in surgical care has been undervalued. However, decentralised surgical services at DHs have been identified as a key component of universal health coverage. Surgical capacity at DHs in Western Cape (WC) Province, South Africa, has not been described.
To describe DH surgical capacity in WC and identify barriers to scaling up surgical capacity at these facilities.
This was a cross-sectional survey of 33 DHs using the World Health Organization surgical situational analysis tool administered to hospital staff from June to December 2019. The survey addressed the following domains: general services and financing; service delivery and surgical volume; surgical workforce; hospital and operating theatre (OT) infrastructure, equipment and medication; and barriers to scaling up surgical care.
Seven of 33 DHs (21%) did not have a functional OT. Of the 28 World Bank DH procedures, small WC DHs performed up to 22 (79%) and medium/large DHs up to 26 (93%). Only medium/large DHs performed all three bellwether procedures. Five DHs (15%) had a full-time surgeon, anaesthetist or obstetrician (SAO). Of DHs without any SAO specialists, 14 (50%) had family physicians (FPs). These DHs performed more operative procedures than those without FPs (p=0.005). Lack of finances dedicated for surgical care and lack of surgical providers were the most reported barriers to providing and expanding surgical services.
WC DH surgical capacity varied by hospital size. However, FPs could play an essential role in surgery at DHs with appropriate training, oversight and support from SAO specialists. Strategies to scale up surgical capacity include dedicated financial and human resources.
地区医院（DH）在外科护理中的作用一直被低估。然而，DH 分散的外科服务已被确定为全民健康覆盖的关键组成部分。南非西开普省（WC）DH 的外科能力尚未得到描述。
描述 WC 地区医院的外科能力，并确定在这些设施扩大外科能力的障碍。
这是一项针对 33 家 DH 的横断面调查，使用世界卫生组织手术情况分析工具对 2019 年 6 月至 12 月期间医院工作人员进行调查。该调查涵盖以下领域：一般服务和融资；服务提供和手术量；外科劳动力；医院和手术室（OT）基础设施、设备和药物；以及扩大外科护理的障碍。
33 家 DH 中有 7 家（21%）没有功能齐全的 OT。在 28 项世界银行 DH 手术中，小 WC DH 完成了多达 22 项（79%），中/大 DH 完成了多达 26 项（93%）。只有中/大 DH 完成了所有三项指标性手术。5 家 DH（15%）有全职外科医生、麻醉师或妇产科医生（SAO）。在没有任何 SAO 专家的 DH 中，有 14 家（50%）有家庭医生（FP）。这些 DH 开展的手术操作比没有 FP 的 DH 多（p=0.005）。缺乏专门用于外科护理的资金以及缺乏外科医生是提供和扩大外科服务的最常见障碍。
WC DH 的外科能力因医院规模而异。然而，在适当的培训、SAO 专家的监督和支持下，家庭医生可以在 DH 中发挥至关重要的作用。扩大外科能力的策略包括专门的财务和人力资源。
