Department of Policy and Advocacy, Operation Smile Ghana, Accra, Ghana.
Department of Policy and Advocacy, Operation Smile, Virginia Beach, Virginia, USA.
Glob Health Action. 2022 Dec 31;15(1):2104301. doi: 10.1080/16549716.2022.2104301.
Conditions amenable to surgical, obstetric, trauma, and anaesthesia (SOTA) care are a major contributor to death and disability in Ghana. SOTA care is an essential component of a well-functioning health system, and better understanding of the state of SOTA care in Ghana is necessary to design policies to address gaps in SOTA care delivery.
The aim of this study is to assess the current situation of SOTA care in Ghana.
A situation analysis was conducted as a narrative review of published scientific literature. Information was extracted from studies according to five health system domains related to SOTA care: service delivery, workforce, infrastructure, finance, and information management.
Ghanaians face numerous barriers to accessing quality SOTA care, primarily due to health system inadequacies. Over 77% of surgical operations performed in Ghana are essential procedures, most of which are performed at district-level hospitals that do not have consistent access to imaging and operative room fundamentals. Tertiary facilities have consistent access to these modalities but lack consistent access to oxygen and/or oxygen concentrators on-site as well as surgical supplies and anaesthetic medicines. Ghanaian patients cover up to 91% of direct SOTA costs out-of-pocket, while health insurance only covers up to 14% of the costs. The Ghanaian surgical system also faces severe workforce inadequacies especially in district-level facilities. Most specialty surgeons are concentrated in urban areas. Ghana's health system lacks a solid information management foundation as it does not have centralized SOTA databases, leading to incomplete, poorly coded, and illegible patient information.
This review establishes that surgical services provided in Ghana are focused primarily on district-level facilities that lack adequate infrastructure and face workforce shortages, among other challenges. A comprehensive scale-up of Ghana's surgical infrastructure, workforce, national insurance plan, and information systems is warranted to improve Ghana's surgical system.
在加纳，适宜手术、产科、创伤和麻醉（SOTA）治疗的病症是导致死亡和残疾的主要原因。SOTA 治疗是运行良好的卫生系统的重要组成部分，为了解决 SOTA 治疗服务提供方面的差距，有必要更好地了解加纳 SOTA 治疗的现状。
本研究旨在评估加纳 SOTA 治疗的现状。
采用已发表科学文献的叙述性综述进行情况分析。根据与 SOTA 治疗相关的五个卫生系统领域（服务提供、劳动力、基础设施、资金和信息管理），从研究中提取信息。
加纳人在获得高质量 SOTA 治疗方面面临诸多障碍，主要是由于卫生系统不足。加纳进行的 77%以上的手术都是基本手术，其中大多数手术是在地区级医院进行的，但这些医院无法持续获得影像学和手术室基本设备。三级医疗机构持续获得这些设备，但无法持续获得现场氧气和/或氧气浓缩器、外科用品和麻醉药物。加纳患者需自付高达 91%的直接 SOTA 费用，而医疗保险仅覆盖 14%的费用。加纳的外科系统还面临严重的劳动力不足，尤其是在地区级设施。大多数专科外科医生都集中在城市地区。加纳的卫生系统缺乏坚实的信息管理基础，因为它没有中央 SOTA 数据库，导致患者信息不完整、编码差且难以辨认。
本综述表明，加纳提供的外科服务主要集中在缺乏足够基础设施且面临劳动力短缺等挑战的地区级设施。加纳需要全面扩大外科基础设施、劳动力、国家保险计划和信息系统，以改善其外科系统。
