Sundar Ashneel, Makutu Jope, Waqainabete Ifereimi, Zhang Grace, Tudravu Jemesa, Turagava Josese, Maoate Kiki, Patel Rajeev, Qin Rennie Xinrui
Department of Surgery, Colonial War Memorial Hospital, Suva, Fiji.
Umanand Prasad School of Medicine and Health Sciences, The University of Fiji, Suva, Fiji.
PLOS Glob Public Health. 2025 Feb 5;5(2):e0003829. doi: 10.1371/journal.pgph.0003829. eCollection 2025.
The Lancet Commission on Global Surgery indicator collection highlighted gaps in surgical, obstetric, and anaesthesia (SOA) care in Fiji. Our study is the first comprehensive assessment of essential SOA care capacity in Fiji to guide national surgical planning. In February 2021, we conducted a cross-sectional survey of public hospitals in Fiji using the World Health Organization-Program in Global Surgery and Social Change surgical assessment tool. We surveyed 18 facilities, including three divisional hospitals (DHs) and 15 subdivisional hospitals (SDHs). Twenty-two functional operating rooms (ORs) and 27 post-anaesthesia care beds served 884,887 people. Surgical care was concentrated in DHs and only delivered in select SDHs during outreaches. While SDHs had OR space, they lacked equipment, supplies, and human resources. From 2016 to 2021, surgical volume per 100,000 population increased by approximately 50% from 1,490 to 2,248; however, SOA specialists density per 100,000 population increased marginally from 5.8 to 7.1. There is significant variation across divisions. The Northern division has more ORs (4.55), SOA specialists (9.1), and surgical volume (3,731) per 100,000 population than the Central (2.40, 7.9, 2,367) and Western (1.78, 5.3, 1,519) divisions. This is due to more OR space and functioning, specialist post creation, and outreach services to SDHs. Policy recommendations include upgrading key SDHs with essential SOA care capacity, growing the SOA workforce, strengthening facility maintenance and climate resilience, and strengthening outreach programs. Investment in surgical care capacity must be urgently increased to meet the population's needs.
《柳叶刀》全球外科委员会指标收集工作凸显了斐济外科、产科和麻醉（SOA）护理方面的差距。我们的研究是对斐济基本SOA护理能力的首次全面评估，以指导国家外科规划。2021年2月，我们使用世界卫生组织全球外科与社会变革项目的外科评估工具，对斐济的公立医院进行了横断面调查。我们调查了18家机构，包括3家分区医院（DHs）和15家分区下属医院（SDHs）。22间功能手术室（ORs）和27张麻醉后护理床位为884,887人提供服务。外科护理集中在分区医院，仅在开展外展服务时在部分分区下属医院提供。虽然分区下属医院有手术室空间，但缺乏设备、物资和人力资源。从2016年到2021年，每10万人口的手术量从1490例增加到2248例，增长了约50%；然而，每10万人口的SOA专科医生密度仅从5.8略微增加到7.1。各分区之间存在显著差异。北部地区每10万人口拥有的手术室（4.55间）、SOA专科医生（9.1名）和手术量（3731例）比中部地区（2.40间、7.9名、2367例）和西部地区（1.78间、5.3名、1519例）更多。这是由于更多的手术室空间和功能、增设专科岗位以及向分区下属医院提供外展服务。政策建议包括提升具备基本SOA护理能力的关键分区下属医院的水平、增加SOA劳动力、加强设施维护和气候适应能力以及加强外展项目。必须紧急增加对外科护理能力的投资，以满足民众的需求。
