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Supervision as a tool for building surgical capacity of district hospitals: the case of Zambia
INTRODUCTION: Many countries in sub-Saharan Africa have adopted task shifting of surgical responsibilities to non-physician clinicians (NPCs) as a solution to address workforce shortages. There is resistance to delegating surgical procedures to NPCs due to concerns about their surgical skills and la...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7098155/ https://www.ncbi.nlm.nih.gov/pubmed/32216789 http://dx.doi.org/10.1186/s12960-020-00467-x |
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author | Gajewski, Jakub Monzer, Nasser Pittalis, Chiara Bijlmakers, Leon Cheelo, Mweene Kachimba, John Brugha, Ruairi |
author_facet | Gajewski, Jakub Monzer, Nasser Pittalis, Chiara Bijlmakers, Leon Cheelo, Mweene Kachimba, John Brugha, Ruairi |
author_sort | Gajewski, Jakub |
collection | PubMed |
description | INTRODUCTION: Many countries in sub-Saharan Africa have adopted task shifting of surgical responsibilities to non-physician clinicians (NPCs) as a solution to address workforce shortages. There is resistance to delegating surgical procedures to NPCs due to concerns about their surgical skills and lack of supervision systems to ensure safety and quality of care provided. This study aimed to explore the effects of a new supervision model implemented in Zambia to improve the delivery of health services by surgical NPCs working at district hospitals. METHODS: Twenty-eight semi-structured interviews were conducted with NPCs and medical doctors at nine district hospitals and with the surgical specialists who provided in-person and remote supervision over an average period of 15 months. Data were analysed using ‘top-down’ and ‘bottom-up’ thematic coding. RESULTS: Interviewees reported an improvement in the surgical skills and confidence of NPCs, as well as better teamwork. At the facility level, supervision led to an increase in the volume and range of surgical procedures done and helped to reduce unnecessary surgical referrals. The supervision also improved communication links by facilitating the establishment of a remote consultation network, which enabled specialists to provide real-time support to district NPCs in how to undertake particular surgical procedures and expert guidance on referral decisions. Despite these benefits, shortages of operating theatre support staff, lack of equipment and unreliable power supply impeded maximum utilisation of supervision. CONCLUSION: This supervision model demonstrated the additional role that specialist surgeons can play, bringing their expertise to rural populations, where such surgical competence would otherwise be unobtainable. Further research is needed to establish the cost-effectiveness of the supervision model; the opportunity costs from surgical specialists being away from referral hospitals, providing supervision in districts; and the steps needed for regular district surgical supervision to become part of sustainable national programmes. |
format | Online Article Text |
id | pubmed-7098155 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-70981552020-03-27 Supervision as a tool for building surgical capacity of district hospitals: the case of Zambia Gajewski, Jakub Monzer, Nasser Pittalis, Chiara Bijlmakers, Leon Cheelo, Mweene Kachimba, John Brugha, Ruairi Hum Resour Health Research INTRODUCTION: Many countries in sub-Saharan Africa have adopted task shifting of surgical responsibilities to non-physician clinicians (NPCs) as a solution to address workforce shortages. There is resistance to delegating surgical procedures to NPCs due to concerns about their surgical skills and lack of supervision systems to ensure safety and quality of care provided. This study aimed to explore the effects of a new supervision model implemented in Zambia to improve the delivery of health services by surgical NPCs working at district hospitals. METHODS: Twenty-eight semi-structured interviews were conducted with NPCs and medical doctors at nine district hospitals and with the surgical specialists who provided in-person and remote supervision over an average period of 15 months. Data were analysed using ‘top-down’ and ‘bottom-up’ thematic coding. RESULTS: Interviewees reported an improvement in the surgical skills and confidence of NPCs, as well as better teamwork. At the facility level, supervision led to an increase in the volume and range of surgical procedures done and helped to reduce unnecessary surgical referrals. The supervision also improved communication links by facilitating the establishment of a remote consultation network, which enabled specialists to provide real-time support to district NPCs in how to undertake particular surgical procedures and expert guidance on referral decisions. Despite these benefits, shortages of operating theatre support staff, lack of equipment and unreliable power supply impeded maximum utilisation of supervision. CONCLUSION: This supervision model demonstrated the additional role that specialist surgeons can play, bringing their expertise to rural populations, where such surgical competence would otherwise be unobtainable. Further research is needed to establish the cost-effectiveness of the supervision model; the opportunity costs from surgical specialists being away from referral hospitals, providing supervision in districts; and the steps needed for regular district surgical supervision to become part of sustainable national programmes. BioMed Central 2020-03-26 /pmc/articles/PMC7098155/ /pubmed/32216789 http://dx.doi.org/10.1186/s12960-020-00467-x Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Gajewski, Jakub Monzer, Nasser Pittalis, Chiara Bijlmakers, Leon Cheelo, Mweene Kachimba, John Brugha, Ruairi Supervision as a tool for building surgical capacity of district hospitals: the case of Zambia |
title | Supervision as a tool for building surgical capacity of district hospitals: the case of Zambia |
title_full | Supervision as a tool for building surgical capacity of district hospitals: the case of Zambia |
title_fullStr | Supervision as a tool for building surgical capacity of district hospitals: the case of Zambia |
title_full_unstemmed | Supervision as a tool for building surgical capacity of district hospitals: the case of Zambia |
title_short | Supervision as a tool for building surgical capacity of district hospitals: the case of Zambia |
title_sort | supervision as a tool for building surgical capacity of district hospitals: the case of zambia |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7098155/ https://www.ncbi.nlm.nih.gov/pubmed/32216789 http://dx.doi.org/10.1186/s12960-020-00467-x |
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