Faculty Collaboration Database

Development of a surgical assessment tool for national policy monitoring & evaluation in Ethiopia: A quality improvement study. Int J Surg 2020 Aug;80:231-240

Date

03/22/2020

Pubmed ID

32198096

DOI

10.1016/j.ijsu.2020.03.025

Scopus ID

2-s2.0-85082738220 (requires institutional sign-in at Scopus site)   6 Citations

Abstract

BACKGROUND: A baseline assessment of surgical capacity is recommended as a first-step to surgical system strengthening in order to inform national policy. In Ethiopia, the World Health Organization's Tool for Situational Analysis (WHO SAT) was adapted to assess surgical, obstetric, and anesthesia capacity as part of a national initiative: Saving Lives Through Safe Surgery (SaLTS). This study describes the process of adapting this tool and initial results.

MATERIALS AND METHODS: The new tool was used to evaluate fourteen hospitals in the Southern Nations, Nationalities, and People's Region of Ethiopia between February and March 2017. Two analytic methods were employed. To compare this data to international metrics, the WHO Service Availability and Readiness Assessment (SARA) framework was used. To assess congruence with national policy, data was evaluated against Ethiopian SaLTS targets.

RESULTS: Facilities had on average 62% of SARA items necessary for both basic surgery and comprehensive surgery. Primary, general, and specialized facilities offered on average 84%, 100%, and 100% of SARA basic surgeries, and 58%, 73% and 90% of SARA comprehensive surgeries, respectively. An average of 68% of SaLTS primary surgeries were available at primary facilities, 83% at general facilities, and 100% at specialized facilities. General and specialized hospitals offered an average of 80% of SaLTS general surgeries, while one specialized hospital offered 38% of SaLTS specialized surgeries.

CONCLUSION: While the modified SaLTS Tool provided evaluation against Ethiopian national benchmarks, the resultant assessment was much lengthier than standard international tools. Analysis of results using the SARA framework allowed for comparison to global standards and provided insight into essential parts of the tool. An assessment tool for national surgical policy should maintain internationally comparable metrics and incorporation into existing surveys when possible, while including country-specific targets.

Author List

Iverson KR, Ahearn O, Citron I, Garringer K, Mukhodpadhyay S, Teshome A, Bekele A, Workneh S, Workneh RS, Zemenfeskudus S, Gultie T, Varghese A, Shrime MG, Meara JG, Burssa D

Author

Katie Iverson MD, MPH Assistant Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Anesthesia
Ethiopia
Female
Health Policy
Hospitals
Humans
Male
Obstetric Surgical Procedures
Pregnancy
Quality Improvement
Surgical Procedures, Operative
World Health Organization