Supervision as a tool for building surgical capacity of district hospitals: the case of Zambia
Supervision as a tool for building surgical capacity of district hospitals: the case of Zambia
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DOI：
10.1186/s12960-020-00467-x
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发表时间：
2020-03-26
影响因子：
4.5
通讯作者：
Brugha, Ruairi
中科院分区：
文献类型：
--
作者：
Gajewski, Jakub;Monzer, Nasser;Brugha, Ruairi
介绍撒哈拉以南非洲的许多国家已经采取了将手术责任转移到非医生临床医生（NPC）的解决方案，以解决劳动力短缺问题。由于担心他们的手术技能和缺乏监督系统以确保所提供的护理的安全和质量，将手术程序委托给NPC是有阻力的。本研究旨在探讨在赞比亚实施的一种新的监督模式的影响，以改善在地区医院工作的外科NPC提供的卫生服务。方法28个半结构化访谈进行了NPC和医生在9个地区医院和外科专家谁提供了在人和远程监督平均为期15个月。采用“自上而下”和“自下而上”的专题编码对数据进行了分析。结果被访者反映NPC的手术技能和信心有所提高，以及更好的团队合作。在设施一级，监督导致外科手术的数量和范围增加，并有助于减少不必要的外科转诊。监督还通过促进建立远程咨询网络改善了通信联系，使专家能够向地区国家护理中心提供实时支持，指导如何进行特定的外科手术，并就转诊决定提供专家指导。尽管有这些好处，但手术室支持人员短缺、缺乏设备和不可靠的电力供应阻碍了最大限度地利用监督。结论：这种监督模式证明了专科医生可以发挥的额外作用，将他们的专业知识带到农村人口中，否则这种手术能力将无法获得。需要进一步研究来确定监督模式的成本效益;外科专家离开转诊医院，在地区提供监督的机会成本;以及定期地区手术监督成为可持续国家计划的一部分所需的步骤。
Introduction Many countries in sub-Saharan Africa have adopted task shifting of surgical responsibilities to non-physician clinicians (NPCs) as a solution to address workforce shortages. There is resistance to delegating surgical procedures to NPCs due to concerns about their surgical skills and lack of supervision systems to ensure safety and quality of care provided. This study aimed to explore the effects of a new supervision model implemented in Zambia to improve the delivery of health services by surgical NPCs working at district hospitals. Methods Twenty-eight semi-structured interviews were conducted with NPCs and medical doctors at nine district hospitals and with the surgical specialists who provided in-person and remote supervision over an average period of 15 months. Data were analysed using 'top-down' and 'bottom-up' thematic coding. Results Interviewees reported an improvement in the surgical skills and confidence of NPCs, as well as better teamwork. At the facility level, supervision led to an increase in the volume and range of surgical procedures done and helped to reduce unnecessary surgical referrals. The supervision also improved communication links by facilitating the establishment of a remote consultation network, which enabled specialists to provide real-time support to district NPCs in how to undertake particular surgical procedures and expert guidance on referral decisions. Despite these benefits, shortages of operating theatre support staff, lack of equipment and unreliable power supply impeded maximum utilisation of supervision. Conclusion This supervision model demonstrated the additional role that specialist surgeons can play, bringing their expertise to rural populations, where such surgical competence would otherwise be unobtainable. Further research is needed to establish the cost-effectiveness of the supervision model; the opportunity costs from surgical specialists being away from referral hospitals, providing supervision in districts; and the steps needed for regular district surgical supervision to become part of sustainable national programmes.