Surgical Care Capacity in Uganda: Government Versus Private Sector Investment

Abstract

Background: Uganda is a low-income country with blended, tiered government health care facilities and private/non-governmental (NGO)/mission hospitals. The population is 84% rural; 100% of referral hospitals and majority of specialist physicians are urban. Summary of background data: This project compared various levels of government hospitals with private/NGO hospitals to determine adequacy to deliver emergency and essential surgical care (EESC) and anesthesia. Methods: Using the WHO Situational Analysis Tool, a representative selection of 38 hospitals (25% of Ugandan hospitals) was assessed for capacity to deliver surgical, anesthetic and obstetric care in 4 domains: infrastructure, human resources, surgeries performed or referred, and equipment. Results: In all facilities, laboratory availability was 86%; anesthesia machines, 66%; generators, 55%; and continuous running water, 42%; oxygen, 32%; and electricity, 26%. Resuscitator bags and mask/tubing were present less than 50% of health facilities. Only 84% of all health facilities had a stethoscope; sterilizers only at 50%. This situation was much more dismal in district hospitals. Surgeons were found at 71% of public hospitals and 63% of NGO/mission hospitals; 60% surgeons, and over 50% of anesthesiologists were only in teaching hospitals; obstetricians almost exclusively in higher-level hospitals. Conclusions: The infrastructure for surgical services and anesthesia were noticeably absent at district hospital level and below, yet were readily available at the tertiary care center level. Overall national and regional referral hospitals were better equipped than NGO facilities, suggesting the government is capable of fully equipping hospitals to provide surgical care. These surveys highlight potential for improvement in surgical care at all levels.