'We are all serving the same Ugandans': A nationwide mixed-methods evaluation of private sector surgical capacity in Uganda

• Published in: PloS one 2019-10, Vol.14 (10), p.e0224215-e0224215
• Main Authors: Albutt, Katherine, Drevin, Gustaf, Yorlets, Rachel R, Svensson, Emma, Namanya, Didacus B, Shrime, Mark G, Kayima, Peter
• Format: Article
• Language: English
• Subjects: Analysis; Anesthesia; Anesthesiology; Blood Banks; Cesarean section; Cesarean Section - statistics & numerical data; Clinical trials; Cross cutting; Data collection; Delay; Delivery of Health Care; Emergency medical services; Equipment and Supplies, Hospital - supply & distribution; Evaluation; Female; Financial management; Health Care Service and Management, Health Policy and Services and Health Economy; Health Resources - supply & distribution; Health Sciences; Health Services Accessibility - economics; Hospitals; Humans; Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi; Hälsovetenskap; Information management; Infrastructure (Economics); Laparotomy; Laparotomy - statistics & numerical data; Logbooks; Medical and Health Sciences; Medical economics; Medical schools; Medicin och hälsovetenskap; Medicine and Health Sciences; Methods; Mixed methods research; Obstetrics; Organizations, Nonprofit; Oxygen; People and Places; Pregnancy; Private sector; Private Sector - statistics & numerical data; Public health; Public sector; Qualitative analysis; Resource availability; Retrospective Studies; Shortages; Social change; Social Sciences; Studies; Support systems; Surgeons - supply & distribution; Surgery; Surgical Procedures, Operative - statistics & numerical data; Uganda
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0224215

Half of all Ugandans (49%) turn to the private or private-not-for-profit (PNFP) sectors when faced with illness, yet little is known about the capacity of these sectors to deliver surgical services. We partnered with the Ministry of Health to conduct a nationwide mixed-methods evaluation of private and PNFP surgical capacity in Uganda. A standardized validated facility assessment tool was utilized to assess facility infrastructure, service delivery, workforce, information management, and financing at a randomized nationally representative sample of 16 private and PNFP hospitals. Semi-structured interviews were conducted to qualitatively explore facilitating factors and barriers to surgical, obstetric and anaesthesia (SOA) care. Hospitals walk-throughs and retrospective reviews of operative logbooks were completed. Hospitals had a median of 177 beds and two operating rooms. Ten hospitals (62.5%) were able to perform all Bellwether procedures (cesarean section, laparotomy and open fracture treatment). Thirty-day surgical volume averaged 102 cases per facility. While most hospitals had electricity, oxygen, running water, and necessary equipment, many reported pervasive shortages of blood, surgical consumables, and anesthetic drugs. Several themes emerged from the qualitative analysis: (1) geographic distance and limited transportation options delay reaching care; (2) workforce shortages impede the delivery of surgical care; (3) emergency and obstetric volume overwhelm the surgical system; (4) medical and non-medical costs delay seeking, reaching, and receiving care; and (5) there is poor coordination of care with insufficient support systems. As in Uganda's public sector, barriers to surgery in private and PNFP hospitals in Uganda are cross-cutting and closely tied to resource availability. Critical policy and programmatic developments are essential to build and strengthen Ugandan surgical capacity across all sectors.