A Resource Planning Analysis of District Hospital Surgical Services in the Democratic Republic of the Congo
A Resource Planning Analysis of District Hospital Surgical Services in the Democratic Republic of the Congo
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DOI：
10.9745/ghsp-d-14-00165
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发表时间：
2015-03-01
影响因子：
4
通讯作者：
Cherian, Meena
中科院分区：
文献类型：
--
作者：
Sion, Melanie;Rajan, Dheepa;Cherian, Meena
背景：手术条件对全球健康的影响，特别是对弱势群体的影响，正在得到认可。然而，只有3.5%的2.342亿例，每年的大手术是在世界上最贫穷的三分之一居住的国家，如民主共和国的刚果（DRC）。方法：麻醉和手术服务的可用性数据收集从12个刚果民主共和国地区医院使用世界卫生组织（WHO）的紧急和基本外科护理情况分析工具。我们对刚果一家基于规范的地区医院以及我们进行情况分析的12家医院中的两家（Demba和Kabare地区医院）的手术服务费用进行了分析，以补充这些数据。对于成本分析，我们使用了世卫组织的综合医疗技术包tool.Results：在调查的32个外科干预措施中，12家医院中只有2家提供了所有基本服务。程序方面的缺陷从没有缺陷到17项服务无法提供不等，平均有7项基本程序无法提供。许多医院没有自来水和电力等基本基础设施; 12家医院中有9家没有供水或供水中断，12家医院中有7家没有供电或供电中断。平均而言，21%的挽救生命的手术干预是从设施缺席，与示范规范医院。根据标准医院，所有外科服务每年将花费每个居民2.17美元，占病人总数的33.3%，但仅占地区医院运营预算总额的18.3%。在Demba医院，手术干预所需的业务预算为每年每名居民0.08美元，在Kabare医院，每年每名居民0.69美元。结论：刚果地区医院解决的健康问题的很大一部分是外科手术，但目前无法满足这种手术需求。在接受调查的地区医院中，服务不足和能力低于标准是系统性的，表现为基础设施、供应、设备和人力资源方面的制约。然而，手术服务是负担得起的，只占总业务预算的一小部分。应更加重视为地区医院提供适当资金，以满足救生手术服务的需要。
Background: The impact of surgical conditions on global health, particularly on vulnerable populations, is gaining recognition. However, only 3.5% of the 234.2 million cases per year of major surgery are performed in countries where the world's poorest third reside, such as the Democratic Republic of the Congo (DRC).Methods: Data on the availability of anesthesia and surgical services were gathered from 12 DRC district hospitals using the World Health Organization's (WHO's) Emergency and Essential Surgical Care Situation Analysis Tool. We complemented these data with an analysis of the costs of surgical services in a Congolese norms-based district hospital as well as in 2 of the 12 hospitals in which we conducted the situational analysis (Demba and Kabare District Hospitals). For the cost analysis, we used WHO's integrated Healthcare Technology Package tool.Results: Of the 32 surgical interventions surveyed, only 2 of the 12 hospitals provided all essential services. The deficits in procedures varied from no deficits to 17 services that could not be provided, with an average of 7 essential procedures unavailable. Many of the hospitals did not have basic infrastructure such as running water and electricity; 9 of 12 had no or interrupted water and 7 of 12 had no or interrupted electricity. On average, 21% of lifesaving surgical interventions were absent from the facilities, compared with the model normative hospital. According to the normative hospital, all surgical services would cost US$2.17 per inhabitant per year, representing 33.3% of the total patient caseload but only 18.3% of the total district hospital operating budget. At Demba Hospital, the operating budget required for surgical interventions was US$0.08 per inhabitant per year, and at Kabare Hospital, US$0.69 per inhabitant per year.Conclusion: A significant portion of the health problems addressed at Congolese district hospitals is surgical in nature, but there is a current inability to meet this surgical need. The deficient services and substandard capacity in the surveyed district hospitals are systemic in nature, representing infrastructure, supply, equipment, and human resource constraints. Yet surgical services are affordable and represent a minor portion of the total operating budget. Greater emphasis should be made to appropriately fund district hospitals to meet the need for lifesaving surgical services.