You pray to your God: A qualitative analysis of challenges in the provision of safe, timely, and affordable surgical care in Uganda,PLOS ONE

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You pray to your God: A qualitative analysis of challenges in the provision of safe, timely, and affordable surgical care in Uganda
PLOS ONE ( IF 2.9 ) Pub Date : 2018-04-17 , DOI: 10.1371/journal.pone.0195986
Katherine Albutt _{1,

2} , Rachel R Yorlets ₁ , Maria Punchak _{1,

3} , Peter Kayima ₄ , Didacus B Namanya _{5,

6} , Geoffrey A Anderson _{1,

2} , Mark G Shrime _{1,

7}

Affiliation

Background

Five billion people lack access to safe, affordable, and timely surgical and anesthesia care. Significant challenges remain in the provision of surgical care in low-resource settings. Uganda is no exception.

Methods

From September to November 2016, we conducted a mixed-methods countrywide surgical capacity assessment at 17 randomly selected public hospitals in Uganda. Researchers conducted 35 semi-structured interviews with key stakeholders to understand factors related to the provision of surgical care. The framework approach was used for thematic and explanatory data analysis.

Results

The Ugandan public health care sector continues to face significant challenges in the provision of safe, timely, and affordable surgical care. These challenges can be broadly grouped into preparedness and policy, service delivery, and the financial burden of surgical care. Hospital staff reported challenges including: (1) significant delays in accessing surgical care, compounded by a malfunctioning referral system; (2) critical workforce shortages; (3) operative capacity that is limited by inadequate infrastructure and overwhelmed by emergency and obstetric volume; (4) supply chain difficulties pertaining to provision of essential medications, equipment, supplies, and blood; (5) significant, variable, and sometimes catastrophic expenditures for surgical patients and their families; and (6) a lack of surgery-specific policies and priorities. Despite these challenges, innovative strategies are being used in the public to provide surgical care to those most in need.

Conclusion

Barriers to the provision of surgical care are cross-cutting and involve constraints in infrastructure, service delivery, workforce, and financing. Understanding current strengths and shortfalls of Uganda’s surgical system is a critical first step in developing effective, targeted policy and programming that will build and strengthen its surgical capacity.

中文翻译：

你向你的上帝祈祷：对乌干达提供安全、及时和负担得起的外科护理所面临的挑战进行定性分析

背景

五十亿人无法获得安全、负担得起且及时的手术和麻醉护理。在资源匮乏的地区提供外科护理仍然面临重大挑战。乌干达也不例外。

方法

2016年9月至11月，我们在乌干达随机选择的17家公立医院进行了混合方法的全国手术能力评估。研究人员对主要利益相关者进行了 35 次半结构化访谈，以了解与提供手术护理相关的因素。框架方法用于主题和解释性数据分析。

结果

乌干达公共卫生保健部门在提供安全、及时和负担得起的外科护理方面继续面临重大挑战。这些挑战可大致分为准备和政策、服务提供以及手术护理的财务负担。医院工作人员报告的挑战包括：(1) 获得外科护理的时间严重延误，转诊系统故障使情况更加复杂；(2) 劳动力严重短缺；(3) 业务能力因基础设施不足而受到限制，并因急诊和产科数量而不堪重负；(4) 与提供基本药物、设备、物资和血液有关的供应链困难；(5) 手术患者及其家属的重大、可变的、有时甚至是灾难性的支出；(6) 缺乏针对手术的具体政策和优先事项。尽管存在这些挑战，公众仍在使用创新策略，为最需要的人提供外科护理。