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Pathways to effective surgical coverage in a lower-middle-income country: A multiple methods study of the family physician-led generalist surgical team in rural Nepal

The Lancet Commission on Global Surgery (LCoGS) recommends using specialist surgical workforce density as one of 6 core indicators for monitoring universal access to safe, affordable surgical and anaesthesia care. Using Nepal as a case study, we explored the capacity of a generalist workforce (led b...

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Autores principales: Ross, Ollie, Shakya, Rabina, Shrestha, Rishav, Shah, Shristi, Pradhan, Amita, Shrestha, Rahul, Bhandari, Pushkar, Paris, Becky, Shah, Kashim, Shrestha, Anil, Zimmerman, Mark, Henrikson, Hannah, Tamang, Suresh, Rajbhandari, Ruma
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021892/
https://www.ncbi.nlm.nih.gov/pubmed/36963001
http://dx.doi.org/10.1371/journal.pgph.0001510
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author Ross, Ollie
Shakya, Rabina
Shrestha, Rishav
Shah, Shristi
Pradhan, Amita
Shrestha, Rahul
Bhandari, Pushkar
Paris, Becky
Shah, Kashim
Shrestha, Anil
Zimmerman, Mark
Henrikson, Hannah
Tamang, Suresh
Rajbhandari, Ruma
author_facet Ross, Ollie
Shakya, Rabina
Shrestha, Rishav
Shah, Shristi
Pradhan, Amita
Shrestha, Rahul
Bhandari, Pushkar
Paris, Becky
Shah, Kashim
Shrestha, Anil
Zimmerman, Mark
Henrikson, Hannah
Tamang, Suresh
Rajbhandari, Ruma
author_sort Ross, Ollie
collection PubMed
description The Lancet Commission on Global Surgery (LCoGS) recommends using specialist surgical workforce density as one of 6 core indicators for monitoring universal access to safe, affordable surgical and anaesthesia care. Using Nepal as a case study, we explored the capacity of a generalist workforce (led by a family physician or MD general practitioner and non-physician anaesthetist) to enable effective surgical delivery through task-shifting. Using a multiple-methods approach, we retrospectively mapped essential surgical care and the enabling environment for surgery in 39 hospitals in 25 remote districts in Nepal and compared it with LCoGS indicators. All 25 districts performed surgery, 21 performed Caesarean section (CS), and 5 met at least 50% of district CS needs. Generalist surgical teams performed CS, the essential major operation at the district level, and very few laparotomies, but no operative orthopaedics. The density of specialist Surgeon/Anaesthesiologist/Obstetrician (SAO) was 0·4/100,000; that of Generalist teams (gSAO) led by a family physician (MD General Practitioners-MDGP) supported by non-physician anaesthetists was eight times higher at 3·1/100,000. gSAO presence was positively associated with a two-fold increase in CS availability. All surgical rates were well below LCoGS targets. 46% of hospitals had adequate enabling environments for surgery, 28% had functioning anaesthesia machines, and 75% had blood transfusion services. Despite very low SAO density, and often inadequate enabling environment, surgery can be done in remote districts. gSAO teams led by family physicians are providing essential surgery, with CS the commonest major operation. gSAO density is eight times higher than specialists and they can undertake more complex operations than just CS alone. These family physician-led functional teams are providing a pathway to effective surgical coverage in remote Nepal.
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spelling pubmed-100218922023-03-17 Pathways to effective surgical coverage in a lower-middle-income country: A multiple methods study of the family physician-led generalist surgical team in rural Nepal Ross, Ollie Shakya, Rabina Shrestha, Rishav Shah, Shristi Pradhan, Amita Shrestha, Rahul Bhandari, Pushkar Paris, Becky Shah, Kashim Shrestha, Anil Zimmerman, Mark Henrikson, Hannah Tamang, Suresh Rajbhandari, Ruma PLOS Glob Public Health Research Article The Lancet Commission on Global Surgery (LCoGS) recommends using specialist surgical workforce density as one of 6 core indicators for monitoring universal access to safe, affordable surgical and anaesthesia care. Using Nepal as a case study, we explored the capacity of a generalist workforce (led by a family physician or MD general practitioner and non-physician anaesthetist) to enable effective surgical delivery through task-shifting. Using a multiple-methods approach, we retrospectively mapped essential surgical care and the enabling environment for surgery in 39 hospitals in 25 remote districts in Nepal and compared it with LCoGS indicators. All 25 districts performed surgery, 21 performed Caesarean section (CS), and 5 met at least 50% of district CS needs. Generalist surgical teams performed CS, the essential major operation at the district level, and very few laparotomies, but no operative orthopaedics. The density of specialist Surgeon/Anaesthesiologist/Obstetrician (SAO) was 0·4/100,000; that of Generalist teams (gSAO) led by a family physician (MD General Practitioners-MDGP) supported by non-physician anaesthetists was eight times higher at 3·1/100,000. gSAO presence was positively associated with a two-fold increase in CS availability. All surgical rates were well below LCoGS targets. 46% of hospitals had adequate enabling environments for surgery, 28% had functioning anaesthesia machines, and 75% had blood transfusion services. Despite very low SAO density, and often inadequate enabling environment, surgery can be done in remote districts. gSAO teams led by family physicians are providing essential surgery, with CS the commonest major operation. gSAO density is eight times higher than specialists and they can undertake more complex operations than just CS alone. These family physician-led functional teams are providing a pathway to effective surgical coverage in remote Nepal. Public Library of Science 2023-02-28 /pmc/articles/PMC10021892/ /pubmed/36963001 http://dx.doi.org/10.1371/journal.pgph.0001510 Text en © 2023 Ross et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Ross, Ollie
Shakya, Rabina
Shrestha, Rishav
Shah, Shristi
Pradhan, Amita
Shrestha, Rahul
Bhandari, Pushkar
Paris, Becky
Shah, Kashim
Shrestha, Anil
Zimmerman, Mark
Henrikson, Hannah
Tamang, Suresh
Rajbhandari, Ruma
Pathways to effective surgical coverage in a lower-middle-income country: A multiple methods study of the family physician-led generalist surgical team in rural Nepal
title Pathways to effective surgical coverage in a lower-middle-income country: A multiple methods study of the family physician-led generalist surgical team in rural Nepal
title_full Pathways to effective surgical coverage in a lower-middle-income country: A multiple methods study of the family physician-led generalist surgical team in rural Nepal
title_fullStr Pathways to effective surgical coverage in a lower-middle-income country: A multiple methods study of the family physician-led generalist surgical team in rural Nepal
title_full_unstemmed Pathways to effective surgical coverage in a lower-middle-income country: A multiple methods study of the family physician-led generalist surgical team in rural Nepal
title_short Pathways to effective surgical coverage in a lower-middle-income country: A multiple methods study of the family physician-led generalist surgical team in rural Nepal
title_sort pathways to effective surgical coverage in a lower-middle-income country: a multiple methods study of the family physician-led generalist surgical team in rural nepal
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021892/
https://www.ncbi.nlm.nih.gov/pubmed/36963001
http://dx.doi.org/10.1371/journal.pgph.0001510
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