Strategic Assessment of Trauma Care Capacity in Ghana
Strategic Assessment of Trauma Care Capacity in Ghana
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DOI：
10.1007/s00268-015-3132-3
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发表时间：
2015-10-01
影响因子：
2.6
通讯作者：
Mock, Charles
中科院分区：
文献类型：
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作者：
Stewart, Barclay T.;Quansah, Robert;Mock, Charles
本研究旨在评估加纳创伤护理技术的可用性。此外，还评估了导致缺陷的因素。通过这样做，可以确定低收入和中等收入国家（LMICs）卫生系统管理效率低下和创伤护理技术不适应的潜在解决方案。方法选取世界卫生组织《创伤基本护理指南》中的32项内容。采用直接检查和与行政、临床和生物医学工程工作人员的结构化访谈来评估40个有目的抽样的地区、区域和三级医院在项目可用性方面的挑战和成功。结果医院评估显示明显不足。其中一些是低成本的，如基本的气道用品、胸管和颈套。项目缺货是由几个因素造成的，即设备缺乏、缺乏培训、经常缺货和技术损坏。确定了造成这些因素的若干根本原因，包括国家保险报销不及时、采购和库存管理做法造成的医疗保健筹资无效，以及当地生物医学工程和创伤护理培训方面的严重差距。尽管如此，还是确定了当地成功克服缺陷的例子（例如，公私伙伴关系，确保公司工程师在技术安装或维修期间培训了在职技术人员）。结论通过改善库存管理和采购政策，可以更好地提供一些低成本物品，但迫切需要纠正国家保险报销制度和对地区医院工作人员的创伤护理培训。此外，随着技术在中低收入国家医疗保健系统中发挥越来越重要的作用，发展当地服务和技术支持能力变得越来越紧迫。
Background This study aimed to assess availability of trauma care technology in Ghana. In addition, factors contributing to deficiencies were evaluated. By doing so, potential solutions to inefficient aspects of health systems management and maladapted technology for trauma care in low-and middle-income countries (LMICs) could be identified.Methods Thirty-two items were selected from the World Health Organization's Guidelines for Essential Trauma Care. Direct inspection and structured interviews with administrative, clinical, and biomedical engineering staff were used to assess the challenges and successes of item availability at 40 purposively sampled district, regional, and tertiary hospitals.Results Hospital assessments demonstrated marked deficiencies. Some of these were low cost, such as basic airway supplies, chest tubes, and cervical collars. Item non-availability resulted from several contributing factors, namely equipment absence, lack of training, frequent stock-outs, and technology breakage. A number of root causes for these factors were identified, including ineffective healthcare financing by way of untimely national insurance reimbursements, procurement and stock-management practices, and critical gaps in local biomedical engineering and trauma care training. Nonetheless, local examples of successfully overcoming deficiencies were identified (e.g., public-private partnering, ensuring company engineers trained technicians on-the-job during technology installation or servicing).Conclusion While availability of several low-cost items could be better supplied by improvements in stock-management and procurement policies, there is a critical need for redress of the national insurance reimbursement system and trauma care training of district hospital staff. Further, developing local service and technical support capabilities is more and more pressing as technology plays an increasingly important role in LMIC healthcare systems.