Urooba Amna, Shah Mashal Murad, Siddiqi Sameen, Afzal Usman, Mehboob Shaheen, Babar Chauhan Sardar Shahmir, Azam Iqbal, Naeem Imran, Latif Asad, Sheikh Lumaan, Khan Sadaf
Centre of Global Surgical Care, Aga Khan University, Karachi, Sindh, Pakistan.
Department of Community Health Sciences, Aga Khan University, Karachi, Sindh, Pakistan.
J Surg Res. 2024 Dec;304:383-390. doi: 10.1016/j.jss.2024.10.031. Epub 2024 Nov 29.
There are numerous reasons for underutilization of the public health sector for surgery in Pakistan. This results in patients being diverted to private hospitals or tertiary care centers in urban areas. Diversions overburden the hospitals and significantly increase out-of-pocket costs for the patients. This study aims to determine the barriers to surgical care in first-level hospitals in Pakistan's Sindh province.
We conducted a concurrent nested mixed methods study from May to June 2021 in public sector first-level hospitals in the Sindh province. Fifteen hospitals in six districts were surveyed. A consolidated hospital assessment tool adapted from the World Health Organization's Tool for Situational Analysis to Assess Emergency and Essential Surgical Care was used for quantitative data collection. Interview guides were developed for staff interviews.
Availability of trained staff was found to be the biggest barrier to the provision of safe surgery. Only eight hospitals had a general surgeon, anesthesiologist, and obstetrician/gynecologist, while the remaining had 1-2 of the three disciplines. Thirteen hospitals had a functioning x-ray machine, while 14 facilities had functioning ultrasound machines with trained personnel to operate them. Only three facilities always had blood available for transfusion. The qualitative component corroborated that the biggest barrier to providing surgical care was the lack of human resources.
The lack of human resources is difficult to overcome. We found evidence of task-shifting to medical officers and trainee anesthesiologists, but this is without discrete regulation and monitoring. Building surgical workforce capacity must be addressed in the interest of quality care.
在巴基斯坦，公共卫生部门的外科手术利用不足有诸多原因。这导致患者被分流至城市地区的私立医院或三级医疗中心。分流使医院负担过重，并显著增加了患者的自付费用。本研究旨在确定巴基斯坦信德省一级医院外科护理的障碍。
2021年5月至6月，我们在信德省公共部门的一级医院开展了一项同步嵌套混合方法研究。对六个地区的15家医院进行了调查。采用了一种根据世界卫生组织《评估急诊和基本外科护理的情景分析工具》改编的综合医院评估工具来收集定量数据。为员工访谈制定了访谈指南。
发现训练有素的工作人员的可获得性是提供安全手术的最大障碍。只有八家医院有普通外科医生、麻醉师和妇产科医生，而其余医院在这三个学科中只有1至2名医生。13家医院有一台可用的X光机，14家机构有可用的超声波机器并有经过培训的人员操作。只有三家机构总是有血液可供输血。定性部分证实，提供外科护理的最大障碍是人力资源短缺。
人力资源短缺难以克服。我们发现了将任务转移给医务人员和实习麻醉师的证据，但这没有明确的监管。为了提供高质量的护理，必须解决建设外科劳动力能力的问题。
