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‘We are all serving the same Ugandans’: A nationwide mixed-methods evaluation of private sector surgical capacity in Uganda

INTRODUCTION: Half of all Ugandans (49%) turn to the private or private-not-for-profit (PNFP) sectors when faced with illness, yet little is known about the capacity of these sectors to deliver surgical services. We partnered with the Ministry of Health to conduct a nationwide mixed-methods evaluati...

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Autores principales: Albutt, Katherine, Drevin, Gustaf, Yorlets, Rachel R., Svensson, Emma, Namanya, Didacus B., Shrime, Mark G., Kayima, Peter
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6812829/
https://www.ncbi.nlm.nih.gov/pubmed/31648234
http://dx.doi.org/10.1371/journal.pone.0224215
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author Albutt, Katherine
Drevin, Gustaf
Yorlets, Rachel R.
Svensson, Emma
Namanya, Didacus B.
Shrime, Mark G.
Kayima, Peter
author_facet Albutt, Katherine
Drevin, Gustaf
Yorlets, Rachel R.
Svensson, Emma
Namanya, Didacus B.
Shrime, Mark G.
Kayima, Peter
author_sort Albutt, Katherine
collection PubMed
description INTRODUCTION: Half of all Ugandans (49%) turn to the private or private-not-for-profit (PNFP) sectors when faced with illness, yet little is known about the capacity of these sectors to deliver surgical services. We partnered with the Ministry of Health to conduct a nationwide mixed-methods evaluation of private and PNFP surgical capacity in Uganda. METHODS: A standardized validated facility assessment tool was utilized to assess facility infrastructure, service delivery, workforce, information management, and financing at a randomized nationally representative sample of 16 private and PNFP hospitals. Semi-structured interviews were conducted to qualitatively explore facilitating factors and barriers to surgical, obstetric and anaesthesia (SOA) care. Hospitals walk-throughs and retrospective reviews of operative logbooks were completed. RESULTS: Hospitals had a median of 177 beds and two operating rooms. Ten hospitals (62.5%) were able to perform all Bellwether procedures (cesarean section, laparotomy and open fracture treatment). Thirty-day surgical volume averaged 102 cases per facility. While most hospitals had electricity, oxygen, running water, and necessary equipment, many reported pervasive shortages of blood, surgical consumables, and anesthetic drugs. Several themes emerged from the qualitative analysis: (1) geographic distance and limited transportation options delay reaching care; (2) workforce shortages impede the delivery of surgical care; (3) emergency and obstetric volume overwhelm the surgical system; (4) medical and non-medical costs delay seeking, reaching, and receiving care; and (5) there is poor coordination of care with insufficient support systems. CONCLUSION: As in Uganda’s public sector, barriers to surgery in private and PNFP hospitals in Uganda are cross-cutting and closely tied to resource availability. Critical policy and programmatic developments are essential to build and strengthen Ugandan surgical capacity across all sectors.
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spelling pubmed-68128292019-11-02 ‘We are all serving the same Ugandans’: A nationwide mixed-methods evaluation of private sector surgical capacity in Uganda Albutt, Katherine Drevin, Gustaf Yorlets, Rachel R. Svensson, Emma Namanya, Didacus B. Shrime, Mark G. Kayima, Peter PLoS One Research Article INTRODUCTION: Half of all Ugandans (49%) turn to the private or private-not-for-profit (PNFP) sectors when faced with illness, yet little is known about the capacity of these sectors to deliver surgical services. We partnered with the Ministry of Health to conduct a nationwide mixed-methods evaluation of private and PNFP surgical capacity in Uganda. METHODS: A standardized validated facility assessment tool was utilized to assess facility infrastructure, service delivery, workforce, information management, and financing at a randomized nationally representative sample of 16 private and PNFP hospitals. Semi-structured interviews were conducted to qualitatively explore facilitating factors and barriers to surgical, obstetric and anaesthesia (SOA) care. Hospitals walk-throughs and retrospective reviews of operative logbooks were completed. RESULTS: Hospitals had a median of 177 beds and two operating rooms. Ten hospitals (62.5%) were able to perform all Bellwether procedures (cesarean section, laparotomy and open fracture treatment). Thirty-day surgical volume averaged 102 cases per facility. While most hospitals had electricity, oxygen, running water, and necessary equipment, many reported pervasive shortages of blood, surgical consumables, and anesthetic drugs. Several themes emerged from the qualitative analysis: (1) geographic distance and limited transportation options delay reaching care; (2) workforce shortages impede the delivery of surgical care; (3) emergency and obstetric volume overwhelm the surgical system; (4) medical and non-medical costs delay seeking, reaching, and receiving care; and (5) there is poor coordination of care with insufficient support systems. CONCLUSION: As in Uganda’s public sector, barriers to surgery in private and PNFP hospitals in Uganda are cross-cutting and closely tied to resource availability. Critical policy and programmatic developments are essential to build and strengthen Ugandan surgical capacity across all sectors. Public Library of Science 2019-10-24 /pmc/articles/PMC6812829/ /pubmed/31648234 http://dx.doi.org/10.1371/journal.pone.0224215 Text en © 2019 Albutt et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://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
Albutt, Katherine
Drevin, Gustaf
Yorlets, Rachel R.
Svensson, Emma
Namanya, Didacus B.
Shrime, Mark G.
Kayima, Peter
‘We are all serving the same Ugandans’: A nationwide mixed-methods evaluation of private sector surgical capacity in Uganda
title ‘We are all serving the same Ugandans’: A nationwide mixed-methods evaluation of private sector surgical capacity in Uganda
title_full ‘We are all serving the same Ugandans’: A nationwide mixed-methods evaluation of private sector surgical capacity in Uganda
title_fullStr ‘We are all serving the same Ugandans’: A nationwide mixed-methods evaluation of private sector surgical capacity in Uganda
title_full_unstemmed ‘We are all serving the same Ugandans’: A nationwide mixed-methods evaluation of private sector surgical capacity in Uganda
title_short ‘We are all serving the same Ugandans’: A nationwide mixed-methods evaluation of private sector surgical capacity in Uganda
title_sort ‘we are all serving the same ugandans’: a nationwide mixed-methods evaluation of private sector surgical capacity in uganda
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6812829/
https://www.ncbi.nlm.nih.gov/pubmed/31648234
http://dx.doi.org/10.1371/journal.pone.0224215
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