Surgical key performance indicators in Ethiopia’s national health information system: Answering the call for global surgery data

Abstract

Background

The lack of quality surgical data is a major barrier to improving global surgical systems. While prior research has focused on snap­shot facility surveys, it is imperative for surgical indicators to be integrated into national health information systems to create sustainability. This study aimed to describe national surgical indicator development and implementation in Ethiopia.

Methods

Fifteen surgical key performance indicators (KPIs) were established through an iterative process with Ethiopia’s Federal Ministry of Health as part of their national flagship programme, Saving Lives Through Safe Surgery (SaLTS). A baseline assessment of data collection and reporting mechanisms was performed at 10 hospitals in 2 regions of Ethiopia. Registries, data collection processes, and reporting forms were then updated. The indicators and resulting data system were piloted at these hospitals through an 8-week training programme.

Results

During the initial needs assessment, deficits in data flow mechanisms were identified for all but 1 indicator: Surgical Volume. One month of surgical data was obtained from each hospital at the end of the intervention. Data quality verifications revealed discrep­ancies at 7 of 10 hospitals, ranging from 1 to 3 indicators. For the 10 hospitals, the mean monthly surgical volume was 40 cases, the inpatient Perioperative Mortality Rate was 1.4% (3 of 220 operations), the inpatient Surgical Site Infection Rate was 0.91% (2 of 220), and the Anaesthetic Adverse Outcome Rate was 1.4% (3 of 220).

Conclusions

This study detailed the process of integrating surgical indicators into a national health information system as part of a broader surgical policy’s monitoring and evaluation strategy. The activities outlined in this article can guide countries with similar aims.