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ABSTRACT
Background
Background: Access to emergency and essential surgical care and anaesthesia is vital for Universal Health Coverage, yet the burden of surgical disease is often underestimated due to insufficient data reporting. Despite their significant needs, low- and middle-income countries perform only 6% of the 313 million global surgical procedures per year. Enhancing surgical capacity in these countries could prevent 1.5 million deaths and 77.2 million disability-adjusted life years annually. South Africa lacks standard surgical and perioperative indicators, hindering evidence-based decision-making. The study aimed to describe the development of a context-specific, basic surgical facility assessment tool for district and regional hospitals in North West, South Africa.
Method
Methods: This study was conducted in North West South Africa and involved thirteen districts and three regional hospitals. From June to August 2024, a Basic Surgical Facility Assessment Tool was used, adapted from the World Health Organization’s Surgical Situational Analysis and the Anaesthesia Facility Assessment Tools. A structured questionnaire was administered at each facility, with data from facility managers supported by the District Health Information System, Health Patient Registration System and theatre registries. Descriptive statistical analyses and geo-mapping were performed.
Result
Results: Eleven of the thirteen district hospitals and three regional hospitals within the public health sector participated. Data availability was primarily sufficient for the assessment tool. However, challenges arose in obtaining demographic and nursing workforce data, highlighting shortcomings in data collection practices. Most facilities had the essential infrastructure, ensuring reliable access to water, electricity, and the internet. Caesarean sections were the most prevalent, whilst district surgical services relied on outreach programmes for more complex procedures, indicating limited in-house capacity. Essential surgical and anaesthetic medications and auxiliary services such as radiography and laboratory support were predominantly available based on the level of care. Health information systems for laboratory and radiology services were widely available. The patient administration system was electronic, while the clinical records were paper-based with restricted access.
Conclusion
Conclusion: The study highlights the capability to utilise a context-specific Basic Surgical Facility Assessment Tool for monitoring surgical and anaesthetic capacity in South Africa. The findings emphasise the necessity for an integrated surgical health information system to support data-driven decisions, enhance surgical service delivery, improve health outcomes and promote Universal Health Coverage.