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Barriers to surgery performed by non-physician clinicians in sub-Saharan Africa—a scoping review

BACKGROUND: Sub-Saharan Africa (SSA) faces the highest burden of disease amenable to surgery while having the lowest surgeon to population ratio in the world. Some 25 SSA countries use surgical task-shifting from physicians to non-physician clinicians (NPCs) as a strategy to increase access to surge...

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Autores principales: van Heemskerken, Phylisha, Broekhuizen, Henk, Gajewski, Jakub, Brugha, Ruairí, Bijlmakers, Leon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7368796/
https://www.ncbi.nlm.nih.gov/pubmed/32680526
http://dx.doi.org/10.1186/s12960-020-00490-y
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author van Heemskerken, Phylisha
Broekhuizen, Henk
Gajewski, Jakub
Brugha, Ruairí
Bijlmakers, Leon
author_facet van Heemskerken, Phylisha
Broekhuizen, Henk
Gajewski, Jakub
Brugha, Ruairí
Bijlmakers, Leon
author_sort van Heemskerken, Phylisha
collection PubMed
description BACKGROUND: Sub-Saharan Africa (SSA) faces the highest burden of disease amenable to surgery while having the lowest surgeon to population ratio in the world. Some 25 SSA countries use surgical task-shifting from physicians to non-physician clinicians (NPCs) as a strategy to increase access to surgery. While many studies have investigated barriers to access to surgical services, there is a dearth of studies that examine the barriers to shifting of surgical tasks to, and the delivery of safe essential surgical care by NPCs, especially in rural areas of SSA. This study aims to identify those barriers and how they vary between surgical disciplines as well as between countries. METHODS: We performed a scoping review of articles published between 2000 and 2018, listed in PubMed or Embase. Full-text articles were read by two reviewers to identify barriers to surgical task-shifting. Cited barriers were counted and categorized, partly based on the World Health Organization (WHO) health systems building blocks. RESULTS: Sixty-two articles met the inclusion criteria, and 14 clusters of barriers were identified, which were assigned to four main categories: primary outcomes, NPC workforce, regulation, and environment and resources. Malawi, Tanzania, Uganda, and Mozambique had the largest number of articles reporting barriers, with Uganda reporting the largest variety of barriers from empirical studies only. Obstetric and gynaecologic surgery had more articles and cited barriers than other specialties. CONCLUSION: A multitude of factors hampers the provision of surgery by NPCs across SSA. The two main issues are surgical pre-requisites and the need for regulatory and professional frameworks to legitimate and control the surgical practice of NPCs.
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spelling pubmed-73687962020-07-20 Barriers to surgery performed by non-physician clinicians in sub-Saharan Africa—a scoping review van Heemskerken, Phylisha Broekhuizen, Henk Gajewski, Jakub Brugha, Ruairí Bijlmakers, Leon Hum Resour Health Review BACKGROUND: Sub-Saharan Africa (SSA) faces the highest burden of disease amenable to surgery while having the lowest surgeon to population ratio in the world. Some 25 SSA countries use surgical task-shifting from physicians to non-physician clinicians (NPCs) as a strategy to increase access to surgery. While many studies have investigated barriers to access to surgical services, there is a dearth of studies that examine the barriers to shifting of surgical tasks to, and the delivery of safe essential surgical care by NPCs, especially in rural areas of SSA. This study aims to identify those barriers and how they vary between surgical disciplines as well as between countries. METHODS: We performed a scoping review of articles published between 2000 and 2018, listed in PubMed or Embase. Full-text articles were read by two reviewers to identify barriers to surgical task-shifting. Cited barriers were counted and categorized, partly based on the World Health Organization (WHO) health systems building blocks. RESULTS: Sixty-two articles met the inclusion criteria, and 14 clusters of barriers were identified, which were assigned to four main categories: primary outcomes, NPC workforce, regulation, and environment and resources. Malawi, Tanzania, Uganda, and Mozambique had the largest number of articles reporting barriers, with Uganda reporting the largest variety of barriers from empirical studies only. Obstetric and gynaecologic surgery had more articles and cited barriers than other specialties. CONCLUSION: A multitude of factors hampers the provision of surgery by NPCs across SSA. The two main issues are surgical pre-requisites and the need for regulatory and professional frameworks to legitimate and control the surgical practice of NPCs. BioMed Central 2020-07-17 /pmc/articles/PMC7368796/ /pubmed/32680526 http://dx.doi.org/10.1186/s12960-020-00490-y 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 Review
van Heemskerken, Phylisha
Broekhuizen, Henk
Gajewski, Jakub
Brugha, Ruairí
Bijlmakers, Leon
Barriers to surgery performed by non-physician clinicians in sub-Saharan Africa—a scoping review
title Barriers to surgery performed by non-physician clinicians in sub-Saharan Africa—a scoping review
title_full Barriers to surgery performed by non-physician clinicians in sub-Saharan Africa—a scoping review
title_fullStr Barriers to surgery performed by non-physician clinicians in sub-Saharan Africa—a scoping review
title_full_unstemmed Barriers to surgery performed by non-physician clinicians in sub-Saharan Africa—a scoping review
title_short Barriers to surgery performed by non-physician clinicians in sub-Saharan Africa—a scoping review
title_sort barriers to surgery performed by non-physician clinicians in sub-saharan africa—a scoping review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7368796/
https://www.ncbi.nlm.nih.gov/pubmed/32680526
http://dx.doi.org/10.1186/s12960-020-00490-y
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