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Strengthening Surgical and Anaesthetic Services at District Level in the African Region: Issues, Challenges and Proposed Actions
Ndihokubwayo, J B; Coulibaly, S O; Cherian, M N; Ekeke, M M; Nabyonga, J; Musango, L; Nkurunziza, T; King, C; Premaratne, I & Johnson, W D
Abstract
Health care delivery systems are organized at several levels with the district hospital
serving as the first referral for comprehensive care in the majority of countries worldwide.
The provision of comprehensive surgical services requires several inputs and tools to be in
place, among which are an adequately trained surgical, anaesthesia and obstetric
healthcare workforce, infrastructure and functioning equipment, and essential medicines
and supplies. These, however, are not in place in the majority of commonly received
surgical cases, such as trauma, obstetric, abdominal and orthopedic emergencies, thus
limiting the capacity of district hospitals to address them. Global and regional public
health initiatives have traditionally neglected the necessity of the provision of surgical
services despite the fact that these constitute an essential component of comprehensive
primary healthcare (PHC)1. In fact, because surgery so frequently cannot be safely
postponed, this deficiency prevents the transfer of patients to a secondary or tertiarylevel
hospital where further care can be provided.2
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