Ministry of Health of Ethiopia, Addis Ababa, Ethiopia.
Jhpiego Ethiopia, Johns Hopkins University Affiliate, Addis Ababa, Ethiopia.
BMC Health Serv Res. 2022 Jul 30;22(1):973. doi: 10.1186/s12913-022-08357-9.
Access to emergency and essential surgical care is still unmet and accessibility is disproportionately inequitable in Ethiopia and other low-and middle-income countries. The aim of this study was to assess surgical care access in terms of capability, capacity, and timeliness of care in different levels of health care in Ethiopia.
A cross-sectional study with retrospective data review was conducted in 172 health facilities from December 30, 2020 to June 10, 2021. Descriptive statistics such as median with interquartile range and proportion were computed using STATA Version 15 statistical software.
Within a 90-day interval of the study period, 69,717 major and minor surgeries, and 33,052 bellwether procedures were performed, and major surgeries accounted for 58% of the surgeries. About 1.6%, 23.56%, 25.34%, and 32.2% of both major and minor, and 3.1%, 12.8%, 27.6%, and 45.3% of bellwether procedures were performed in health center OR blocks, primary, general, and specialized hospitals, respectively. Private hospitals performed 17.33% of major and minor and 11.2% of bellwether procedures for the period. The average pre-admission waiting time for surgical patients in primary, general, and specialized hospitals was 9.68, 37.6, and 35.9 days, respectively, whereas, in private hospitals, the average pre-admission waiting time was 1.42 days. On average, surgical patients traveled 5 Hrs, 11 Hrs, 28.4 Hrs, and 21.3 Hrs to access surgical services in primary, general, specialized, and private hospitals, respectively. The surgical workforce to the population served ratio was 7.5, 1.15, and 1.31/100.000 population in primary, specialized and general hospitals, respectively.
Most surgical procedures were performed in specialized hospitals, indicating that there is a burden in these health facilities. The pre-admission waiting time for surgical patients was long in higher-level public hospitals. Surgical patients traveled a long distance to access surgical service in higher level hospitals. The ratio of surgical workforce per 100,000 population served was low in all levels of public health facilities in general, and in higher level hospitals in particular. Efforts should therefore be made to strengthen all levels of the health system and improve surgical care access in terms of capacity, capability, and timeliness in the country.
在埃塞俄比亚和其他中低收入国家，紧急和基本外科护理的可及性仍然无法满足，而且获得途径极不平等。本研究旨在评估不同级别医疗保健机构的外科护理获取能力、能力和及时性。
本横断面研究采用回顾性数据分析，于 2020 年 12 月 30 日至 2021 年 6 月 10 日期间在 172 个卫生设施中进行。使用 STATA 版本 15 统计软件计算中位数（四分位距和比例）等描述性统计数据。
在研究期间的 90 天内，共进行了 69717 例大手术和小手术以及 33052 例引导性手术，大手术占手术的 58%。主要和次要手术以及引导性手术分别有 1.6%、23.56%、25.34%和 32.2%、3.1%、12.8%、27.6%和 45.3%在卫生中心 OR 块、初级、综合和专科医院进行。私营医院在该期间进行了 17.33%的大手术和小手术以及 11.2%的引导性手术。初级、综合和专科医院外科患者的平均术前等待时间分别为 9.68、37.6 和 35.9 天，而私营医院的平均术前等待时间为 1.42 天。平均而言，外科患者分别需要 5 小时、11 小时、28.4 小时和 21.3 小时才能在初级、综合、专科医院和私立医院获得外科服务。初级、专科医院和综合医院每 10 万人的外科劳动力与服务人口的比例分别为 7.5、1.15 和 1.31/100000。
大多数外科手术都在专科医院进行，这表明这些卫生机构负担过重。外科患者在较高级别的公立医院的术前等待时间较长。外科患者在前往较高级别医院时需要长途跋涉。一般来说，公立医疗机构各级外科劳动力与服务人口的比例都较低，特别是在较高级别医院。因此，应努力加强各级卫生系统，并在能力、能力和及时性方面改善该国的外科护理获取。
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