Gazzetta Joshua, Makasa Emmanuel Malabo, Mwale Moses, Phiri Cyrus, Mulenga Mwamba Josephine Chiteba, Mpabalwani Mutimba Bernard, Mwape Lillian, Lishimpi Kennedy
Department of Surgery, University of Virginia and Centre for Surgical Healthcare Research, Charlottesville, Virginia, USA.
Centre for Surgical Healthcare Research, Department of Surgery, University Teaching Hospital, Lusaka, Zambia.
World J Surg. 2025 Jun;49(6):1484-1489. doi: 10.1002/wjs.12615. Epub 2025 May 6.
Recognizing unmet surgical needs in low- and middle-income countries (LMICs) has led to worldwide initiatives to scale-up surgical capacity. The Republic of Zambia is preparing for its first National Surgical Obstetric and Anesthesia Plan (NSOAP) revision and there is limited data on Zambia's surgical healthcare capacity. We aim to highlight Zambia's surgical healthcare capacity to inform the NSOAP revision and the method used for the rapid assessment.
The Emergency and Essential Surgical (Perioperative) Healthcare Health Facility Assessment Tool (ZAMSAT) was fashioned. ZAMSAT survey responses were used to provide a cross-sectional assessment of leveled healthcare facilities nationwide. The survey was distributed to 227 first-, second-, and third-level hospitals under the leadership of Zambia's Operating Theater Nurses Interest Group and the MOH. The WhatsApp messenger application was used for survey distribution and collection.
Data from 116 leveled facilities in all 10 provinces were captured for a survey response rate of 51.1%. A mix of public, private, and mission/nonprofit hospitals was included. The uninterrupted supply of electricity, oxygen, and clean water was found in less than 40% of all facilities. The overall ability to perform caesarean deliveries was 89%, but the ability to perform a laparotomy or open fracture management was significantly lower at 71% and 37%, respectively. Both the WHO Surgical Safety Checklist and pulse-oximetry use in the theater are consistently used more than 85% of the time. General doctors and anesthesia providers are responsible for the majority of intraoperative care in Zambia. Two-percent of facilities are using electronic records as their only means of medical record keeping. The most common research being performed is observational. Although 7% of facilities report a dedicated budget line for perioperative care, only 30% report the budget is adequate. Forty-percent of facilities have local committees dedicated to perioperative care and only 43% of facilities were aware of the NSOAP (2017-2021).
ZAMSAT successfully quantified nationwide perioperative healthcare capacity data to inform the Republic of Zambia's first NSOAP revision. The assessment highlights important gaps in each NSOAP domain that may be addressed to advance perioperative healthcare in Zambia.
认识到低收入和中等收入国家（LMICs）未满足的外科需求促使全球范围内开展扩大外科手术能力的倡议。赞比亚共和国正在筹备首次修订国家外科、产科和麻醉计划（NSOAP），但关于赞比亚外科医疗保健能力的数据有限。我们旨在突出赞比亚的外科医疗保健能力，为NSOAP修订及快速评估所采用的方法提供信息。
制定了紧急和基本外科（围手术期）医疗保健设施评估工具（ZAMSAT）。ZAMSAT调查回复用于对全国各级医疗保健设施进行横断面评估。该调查在赞比亚手术室护士兴趣小组和卫生部的领导下分发给227家一级、二级和三级医院。通过WhatsApp信使应用程序进行调查分发和收集。
收集了来自所有10个省份116家分级设施的数据，调查回复率为51.1%。纳入了公立、私立以及教会/非营利性医院。不到40%的设施能持续供应电力、氧气和清洁水。进行剖宫产的总体能力为89%，但进行剖腹手术或开放性骨折处理的能力明显较低，分别为71%和37%。世卫组织外科手术安全检查表和手术室脉搏血氧饱和度仪的使用率一直超过85%。在赞比亚，普通医生和麻醉人员负责大部分术中护理。2%的设施将电子记录作为唯一的病历保存方式。开展最多的研究是观察性研究。尽管7%的设施报告有围手术期护理专项预算项目，但只有30%报告预算充足。40%的设施设有围手术期护理地方委员会，只有43%的设施知晓NSOAP（2017 - 2021年）。
ZAMSAT成功量化了全国围手术期医疗保健能力数据，为赞比亚共和国首次NSOAP修订提供了信息。该评估突出了每个NSOAP领域中的重要差距，可针对这些差距推进赞比亚的围手术期医疗保健。
