A mixed-methods assessment of surgical capacity in Tanzania’s Lake Zone

Abstract

Background

Five billion people across the world do not have access to safe and affordable surgical, obstetric, and anaesthesia care when they need it. In 2018, Safe Surgery 2020 was launched in Tanzania’s Lake Zone region to improve the quality of surgical services. A baseline assessment of surgical capacity was undertaken to provide the context for the implementation of Safe Surgery 2020.

Methods

The surgical capacity assessment focused on 5 domains of the surgical system: workforce, service delivery, infrastructure, infor­mation management, and financing. We used a mixed-methods study design, including (1) a cross-sectional survey of 20 health facilities and (2) semistructured interviews (n=34) with surgical team members at 10 health facilities in the Lake Zone of Tanzania between April and July 2018. We used descriptive analysis to quantify surgical capacity and thematic analysis of interview data to gain a deeper understanding of underlying capacity issues and implications.

Results

Surgical, obstetric and anaesthesia workforce density was low at 0.08 surgical, obstetric and anaesthesia providers per 100 000 population. Surgery was performed primarily by general physicians or nonphysician providers and anaesthesia by nurse–anaes­thetists. Among 4993 operations captured across the 3 months of baseline data collection in the 5 regions, only 2 of the 3 bell­wether procedures—caesarean delivery (n=2640, 54%) and laparotomies (n=388, 8%) were performed. Oxygen, blood, water and electricity were not consistently available in all 20 facilities. The majority of facilities lacked postoperative recovery and intensive care units. The majority of facilities (n=18, 90% of facilities) reported that 1% to 25% of their patients had health insurance. The majority of facilities (n=12, 60%) had specific funds allocated to surgery in their hospital operating budgets.

Conclusions

The surgical capacity assessment revealed critical gaps in each of the 5 domains of the surgical system. Results served as a baseline for the Safe Surgery 2020 intervention and can guide interventions to strengthen the surgical system in Tanzania’s Lake Zone and other low-resource settings with similar contexts.