Perioperative capacity and contextual challenges in teaching hospitals of southern Ethiopia: explanatory sequential mixed-methods research

• Published in: Perioperative medicine (London) 2024-06, Vol.13 (1), p.61-14, Article 61
• Main Authors: Mulugeta, Hailemariam, Zemedkun, Abebayehu, Mergia, Getachew, Abate, Semagn M, Gebremariam, Mintesnot, Jemal, Bedru, Nenko, Getachew, Gebremichael, Genet, Besha, Aschalew, Aregu, Mekonnen B
• Format: Article
• Language: English
• Subjects: Biological products; Health care reform; Medical care; Medical care, Cost of; Medical research; Medically uninsured persons; Medicine, Experimental; Methods; National health insurance; Patient Safety; Perioperative capacity; Quality management; Safe surgery; Surgical capacity; Surgical care; Surveys; Universal health coverage
• ISSN: 2047-0525; 2047-0525
• DOI: 10.1186/s13741-024-00423-6

Previous Ethiopian literature on surgical capacity and challenges has focused on quantitative investigations, lacking contextual understanding. This explanatory sequential mixed-methods research (MMR) aimed to assess perioperative capacity and contextual challenges at three teaching hospitals in southern Ethiopia. A quantitative survey assessed workforce, infrastructure, service delivery, financing, and information systems. The survey findings were explained by qualitative semi-structured interviews of twenty perioperative providers. Descriptive statistics were integrated with qualitative thematic analysis findings using the narrative waving approach. Key findings from both datasets were linked using a joint display table. The survey revealed shortages in the specialist workforce (with a ratio of 0.58 per 100,000 population), surgical volume (at 115 surgeries per 100,000 population), equipment, supplies, financing, and perioperative data tracking. Hospitals' radiology services and blood products were only available 25-50% of the time, while anesthetic agents and essential laboratory services were often available 51-75% of the time. Perioperative management protocols were used rarely (1-25% of the time). Over 90% of patients lack health insurance coverage. Qualitative data also revealed scarcity of perioperative resources and equipment; unaffordable perioperative costs, lack of health insurance coverage, and unforeseen expenses; poor patient safety culture and communication barriers across the perioperative continuum of care; workforce shortages, job dissatisfaction, and concerns of competence; and weak national governance, and sociopolitical turmoil, and global market volatility exacerbating local challenges. These challenges are linked to risks in quality of care and patient safety, according to clinicians. The study identifies deficiencies in the health system and sociopolitical landscape affecting safe surgery conduct. It highlights the need for comprehensive health system strengthening to expand workforce, upgrade facilities, improve safety culture, resilience, and leadership to ensure timely access to essential surgery. Exploring external factors, such as the impact of national governance and sociopolitical stability on reform efforts is also essential.