Abstract
The World Health Organization states that essential, cost-effective surgical care should be delivered at district hospitals. In South Africa significant skills gap exist at district hospitals, particularly in the area of surgery and anaesthesia. These small to moderate sized hospitals are too small to support a range of full time specialists even if they could be recruited and were cost-effective. Family physicians (FPs) are trained in the clinical skills required for district hospitals and primary health care. Clinical associates have also been introduced to perform procedures at district hospitals. This report illustrates the contribution of a FP to surgical care at Zithulele Hospital in the Eastern Cape. Family physicians not only bring the necessary clinical skills set but also increase the confidence and capacity of the whole team. Outreach and support by surgeons, as well as continuing professional development, are important. Surgical and anaesthetic skills must be developed together. Family physicians also bring leadership and clinical governance skills that ensure the inputs to support surgery, such as equipment and information systems are available. The contribution of FPs to surgery and district hospitals is overlooked in both policy and practice. Human resources for health policy should recognise their contribution and increase the numbers available and FP posts at district hospitals. There is also a need to update the package of emergency and essential surgical procedures in policy.
Highlights
The World Health Organization states that essential, cost-effective surgical care should be delivered at district hospitals (DHs).[1]
The DHs in South Africa (SA) are small to medium sized facilities, often situated in rural and even remote areas and usually the most accessible hospitals for local communities and for referrals from primary care. They are staffed by medical officers and most of them are involved in community service or are quite junior
It has been widely noticed that substantial skills gap exist at these hospitals, in terms of essential surgical and anaesthetic services.[3,4,5]
Summary
The World Health Organization states that essential, cost-effective surgical care should be delivered at district hospitals (DHs).[1]. That the DH could provide the capacity for training in most surgical skills needed in the district health system,[8] performing surgery is not the only responsibility of FP Their roles extend from being a consultant and clinician to leading clinical governance and building capacity in the team.[7]. To be able to function in a DH setting, one needs to be comfortable with spinal and general anaesthesia, as well as some blocks (e.g. brachial block) and safe conscious sedation techniques In this area, the FP, often by virtue of being older and more experienced, plays a critical role in transferring anaesthetic skills and giving doctors the confidence to do anaesthesia. Training programmes need 50–80 registrar posts each and each province needs to create five new family FP posts a year to achieve this initial goal
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