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Zhang M, Gajewski J, Pittalis C, Shrime M, Broekhuizen H, Ifeanyichi M, Clarke M, Borgstein E, Lavy C, Drury G, Juma A, Mkandawire N, Mwapasa G, Kachimba J, Mbambiko M, Chilonga K, Bijlmakers L, Brugha R. Surgical capacity, productivity and efficiency at the district level in Sub-Saharan Africa: A three-country study. PLoS One 2022; 17:e0278212. [PMID: 36449505 PMCID: PMC9710758 DOI: 10.1371/journal.pone.0278212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 11/12/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Efficient utilisation of surgical resources is essential when providing surgical care in low-resources settings. Countries are developing plans to scale up surgery, though insufficiently based on empirical evidence. This paper investigates the determinants of hospital efficiency in district hospitals in three African countries. METHODS Three-month data, comprising surgical capacity indicators and volumes of major surgical procedures collected from 61 district-level hospitals in Malawi, Tanzania, and Zambia, were analysed. Data envelopment analysis was used to calculate average hospital efficiency scores (max. = 1) for each country. Quantile regression analysis was selected to estimate the relationship between surgical volume and production factors. Two-stage bootstrap regression analysis was used to estimate the determinants of hospital efficiency. RESULTS Average hospital efficiency scores were 0.77 in Tanzania, 0.70 in Malawi and 0.41 in Zambia. Hospitals with high efficiency scores had significantly more surgical staff compared with low efficiency hospitals (DEA score<1). Hospitals that scored high on the most commonly utilised surgical capacity index were not the ones with high surgical volumes or high efficiency. The number of surgical team members, which was lowest in Zambia, was strongly, positively correlated with surgical productivity and efficiency. CONCLUSION Hospital efficiency, combining capacity measures and surgical outputs, is a better indicator of surgical performance than capacity measures, which could be misleading if used alone for surgical planning. Investment in the surgical workforce, in particular, is critical to improving district hospital surgical productivity and efficiency.
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Affiliation(s)
- Mengyang Zhang
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
- * E-mail:
| | - Jakub Gajewski
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Chiara Pittalis
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mark Shrime
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Henk Broekhuizen
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Martilord Ifeanyichi
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Morgane Clarke
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eric Borgstein
- Department of Surgery, University of Malawi College of Medicine, Blantyre, Malawi
| | - Chris Lavy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Grace Drury
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Adinan Juma
- East Central and Southern Africa Health Community, Arusha, United Republic of Tanzania
| | - Nyengo Mkandawire
- Department of Surgery, University of Malawi College of Medicine, Blantyre, Malawi
| | - Gerald Mwapasa
- Department of Surgery, University of Malawi College of Medicine, Blantyre, Malawi
| | - John Kachimba
- Department of Surgery, Surgical Society of Zambia, University of Zambia University Teaching Hospital, Lusaka, Zambia
| | | | - Kondo Chilonga
- Department of Surgery, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Leon Bijlmakers
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ruairi Brugha
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
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Shapiro LM, Castro Appiani LM. Hand Surgery Outreach-From Short-Term "Missions" to Capacity Building. J Hand Surg Am 2022; 47:1005-1010. [PMID: 36050196 PMCID: PMC9621604 DOI: 10.1016/j.jhsa.2022.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/27/2022] [Indexed: 02/02/2023]
Abstract
Although great advancements have been made in global health over the past decades, progress has not been equivalent across the world. For example, the surgical burden (number of surgical cases per capita) remains highest in low- and middle-income countries (LMICs-a term used by The World Bank to classify countries on the basis of their gross national income), where there are frequently fewer surgeons per capita. Surgical outreach is on the rise, with the United States sponsoring more than 2,000 trips annually to LMICs to help address the mismatch in per capita surgical cases to per capita surgeons. These trips, however, are typically short-term in nature and effect and can have unintended consequences. In contrast, capacity building focuses on bidirectional partnerships to educate and empower individuals and organizations such that their care for the local community is enhanced. Capacity building is a priority of leading organizations (including the World Health Organization) but has often been absent in orthopedic and hand surgery outreach. We detail the evidence supporting the transition from short-term mission-based trips to that of capacity building, what we can learn from other specialties about capacity building, and how we can measure and build capacity to improve health in LMICs using our partnership with Costa Rican hand and upper-extremity surgeons as an example.
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Affiliation(s)
- Lauren M Shapiro
- Department of Orthopaedic Surgery, University of California - San Francisco, San Francisco, CA.
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Bhatia R, Lichter KE, Gurram L, MacDuffie E, Lombe D, Sarria GR, Grover S. The state of gynecologic radiation therapy in low- and middle-income countries. Int J Gynecol Cancer 2022; 32:421-428. [PMID: 35256432 PMCID: PMC10042220 DOI: 10.1136/ijgc-2021-002470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/14/2021] [Indexed: 02/04/2023] Open
Abstract
A disproportionate burden of gynecologic malignancies occurs in low- and middle-income countries. Radiation therapy is an integral component of treatment for gynecologic malignancies both from a curative (locally advanced cervical cancer) and palliative (bleeding cervical or pelvic mass) standpoint. Critical to understanding how better to serve patients in this regard is understanding both the extent of disease epidemiology and the radiotherapy infrastructure to treat these diseases. In this review, we explore various geographic regions and how they address a unique set of challenges specific to the peoples and culture of the region. We identify common threads across regions, including sparse distribution of radiation equipment, geographic access, and specialized training. We also highlight examples of success in the use of telemedicine and cross-cultural partnerships to help bolster access to training to ensure increased access to adequate and appropriate treatment of gynecologic malignancies.
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Affiliation(s)
- Rohini Bhatia
- Department of Radiation Oncology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Katie E Lichter
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California, USA
| | - Lavanya Gurram
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Emily MacDuffie
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dorothy Lombe
- Department of Oncology, Cancer Diseases Hospital, Lusaka, Zambia
| | - Gustavo R Sarria
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Nordrhein-Westfalen, Germany
| | - Surbhi Grover
- Department of Radiation Oncology, Botswana-University of Pennsylvania Partnership, Philadelphia, Pennsylvania, USA .,University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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El Saghir NS, Anderson BO, Gralow J, Lopes G, Shulman LN, Moukadem HA, Yu PP, Hortobagyi G. Impact of Merit-Based Immigration Policies on Brain Drain From Low- and Middle-Income Countries. JCO Glob Oncol 2021; 6:185-189. [PMID: 32023124 PMCID: PMC7051246 DOI: 10.1200/jgo.19.00266] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Brain drain is the migration of educated and skilled individuals from a less developed region or country to a more economically established one. The Trump administration proposed a merit-based immigration plan. This article addresses its potential impact on health care delivery in low- and middle-income countries (LMICs) and their preparedness to deal with it. MATERIALS AND METHODS Data on immigration policies, numbers of international medical graduates practicing in high-income countries (HICs), various scientific exchange methods, and efforts for capacity building in LMICs. RESULTS Talented individuals seek to advance their knowledge and skills, and may stay in HICs because of greater rewards and opportunities. HICs also rely on immigrant international medical graduates to supplement their physician workforces. CONCLUSION Ambitious individuals from LMICs need and should have opportunities to advance their education and training in more advanced countries. LMICs should increase their educational efforts, research capabilities, infrastructures, and living conditions to better serve their own populations and reduce their brain drain phenomenon.
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Affiliation(s)
- Nagi S El Saghir
- Division of Hematology Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Benjamin O Anderson
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA
| | - Julie Gralow
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA
| | - Gilberto Lopes
- Sylvester Comprehensive Cancer Center at the University of Miami and the Miller School of Medicine, Miami, FL
| | | | - Hiba A Moukadem
- Division of Hematology Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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