Thursday, April 27, 2017

Baseline Hospital Assessments in Rwanda

Kristin Ojomo MD
Arthur Tracy Cabot Research Fellow / Henry Ellis Warren Fellow
Center for Surgery and Public Health
Brigham and Women’s Hospital

Baseline Hospital Assessments in Rwanda
My time in Rwanda is also dedicated to working with the Ministry of Health to form a National Surgical Plan. An estimated 58.7% of Rwandans currently do not have access to timely, safe, and affordable surgical and anaesthesia care. Whereas surgery has traditionally been a neglected part of health care worldwide, recent research and evidence demonstrate that surgery must become a priority in strengthening health systems. During the 2015 World Health Assembly, Rwanda took an active role in drafting Resolution 68.15 to prioritize emergency and essential surgical care and anaesthesia as a part of universal heal In 2013, The Lancet initiated a process to convene experts in surgery and anaesthesia, researchers, economists, and policymakers to address the state of surgery worldwide and to provide concrete recommendations for its improvement. The Lancet Commission on Global Surgery culminated in the release of the seminal report, Global Surgery 2030.  This report included startling findings: 5 billion people do not have access to safe, affordable, and timely surgical and anaesthesia care. 143 million additional procedures are needed worldwide to meet the gap between available and necessary procedures.  At least a quarter of patients who do receive surgery are financially impoverished as a result. Economic losses from burden of surgical illness amounted to almost 2% of the GDP of low and middle-income economies. The work of the Commission showed that investing in surgery and anaesthesia is a critical component of sound economic growth. Additionally, the Commission recommended a pathway for countries to be able to scale-up surgical access and services in a coordinated and effective manner.  This pathway, called the National Surgical Plan framework, presents concrete recommendations in the five essential domains of an effective and resilient surgical system: (1) infrastructure (2) workforce (3) service delivery (4) information management and (5) financing.

The Republic of Rwanda is a low-income country in sub-Saharan Africa. It has the highest population density in East Africa (total 11.5 million), with most people living in rural areas.  In 2015, the average life expectancy in Rwanda was 66.7 years, and maternal mortality was 210 per 100,000 live births (DHS 2015). The Rwandan government spends 7.5% of its GDP on health expenditures (World Bank 2014). As of 2014, there are 478 health centers, 35 district hospitals, 4 provincial hospitals, and 8 national referral hospitals (Annual Health Statistics Booklet 2014). Out of the 35 district hospitals, only a small minority are currently able to provide emergency and essential surgical services, as described by Disease Control Priorities, Third Edition (DCP3).

Working with the Rwanda Surgical Society, and the Program for Global Surgery and Social Change (Boston Children’s Hospital) we have started the process of drafting a national surgical plan. The first step in this process is baseline hospital assessments to be able to define the current landscape of surgical care. Along with 10 residents from the University of Kigali, I helped carry out hospital assessments of all 42 district hospitals. We are currently undergoing the analysis and will present our findings to the Ministry of Health to further guide the priorities of the National Surgical Plan.  This week, I will be traveling back to Rwanda to continue this process by holding a NSP workshop where all the major stakeholders for the country will get together to start discussing different aspects of the NSOAP including workforce, infrastructure, service delivery, information and management, and financing. Our plan is to complete a draft of the plan by the end of May.
Residents visiting a district hospital to carry out a surgical hospital assessment.

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