Development of a surgical assessment tool for national policy monitoring & evaluation in Ethiopia: A quality improvement study

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...

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Bibliographic Details
Published in:	International journal of surgery (London, England) Vol. 80; pp. 231 - 240
Main Authors:	Iverson, K.R., Ahearn, O., Citron, I., Garringer, K., Mukhodpadhyay, S., Teshome, A., Bekele, A., Workneh, S., Workneh, R.S., Zemenfeskudus, S., Gultie, T., Varghese, A., Shrime, M.G., Meara, J.G., Burssa, D.
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01-08-2020
Subjects:	Anesthesia - standards Ethiopia Female Global surgery Health Policy Hospitals - standards Humans LMICs Male National surgical planning Obstetric Surgical Procedures - standards Pregnancy Quality Improvement Surgical Procedures, Operative - standards World Health Organization Ethiopia Health policy LMICs National surgical planning Ethiopia Global surgery
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Summary:	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. 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. 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. 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. •A surgical baseline assessment is advised for national surgical system strengthening.•The WHO Situational Analysis Tool was adapted and piloted in Ethiopia.•Two analytic methods were used to compare data to national and international metrics.•Our paper highlights the strengths and limitations of these complimentary methods.•National surgical data should be globally comparable and contextually relevant.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1743-9191 1743-9159
DOI:	10.1016/j.ijsu.2020.03.025