Access to emergency and surgical care in sub-Saharan Africa: the infrastructure gap

• Published in: Health policy and planning Vol. 27; no. 3; pp. 234 - 244
• Main Authors: Hsia, Renee Y, Mbembati, Naboth A, Macfarlane, Sarah, Kruk, Margaret E
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-05-2012; Oxford Publishing Limited (England)
• Subjects: Africa; Africa South of the Sahara; Democracy; Developed countries; Developing countries; Emergency medical care; Emergency Medical Services - organization & administration; Emergency Medical Services - supply & distribution; Ghana; Hazardous waste; Hazardous wastes; Health administration; Health care access; Health centres; Health Facilities - supply & distribution; Health Services Accessibility - organization & administration; Health Services Accessibility - statistics & numerical data; Hospitals; Humans; Infrastructure; Inventory; Kenya; Low income countries; Low income groups; Medical care; Original articles; Public infrastructure; Rwanda; Storage; Studies; Sub-Saharan Africa; SubSaharan Africa; Surgery; Surgical Procedures, Operative - statistics & numerical data; Tanzania; Trauma centers; Uganda; World health organization; Africa South of the Sahara; Sub-Saharan Africa
• ISSN: 0268-1080; 1460-2237
• DOI: 10.1093/heapol/czr023

Background The effort to increase access to emergency and surgical care in low-income countries has received global attention. While most of the literature on this issue focuses on workforce challenges, it is critical to recognize infrastructure gaps that hinder the ability of health systems to make emergency and surgical care a reality. Methods This study reviews key barriers to the provision of emergency and surgical care in sub-Saharan Africa using aggregate data from the Service Provision Assessments and Demographic and Health Surveys of five countries: Ghana, Kenya, Rwanda, Tanzania and Uganda. For hospitals and health centres, competency was assessed in six areas: basic infrastructure, equipment, medicine storage, infection control, education and quality control. Percentage of compliant facilities in each country was calculated for each of the six areas to facilitate comparison of hospitals and health centres across the five countries. Results The percentage of hospitals with dependable running water and electricity ranged from 22% to 46%. In countries analysed, only 19-50% of hospitals had the ability to provide 24-hour emergency care. For storage of medication, only 18% to 41% of facilities had unexpired drugs and current inventories. Availability of supplies to control infection and safely dispose of hazardous waste was generally poor (less than 50%) across all facilities. As few as 14% of hospitals (and as high as 76%) among those surveyed had training and supervision in place. Results Conclusions No surveyed hospital had enough infrastructure to follow minimum standards and practices that the World Health Organization has deemed essential for the provision of emergency and surgical care. The countries where these hospitals are located may be representative of other low-income countries in sub-Saharan Africa. Thus, the results suggest that increased attention to building up the infrastructure within struggling health systems is necessary for improvements in global access to medical care.