Supervision as a tool for building surgical capacity of district hospitals: the case of Zambia

Autor: Leon Bijlmakers, Chiara Pittalis, Jakub Gajewski, Mweene Cheelo, Ruairi Brugha, Nasser Monzer, John Kachimba
Rok vydání: 2019
Předmět:
Capacity Building
Public Administration
Referral
media_common.quotation_subject
Health Personnel
Zambia
Health administration
Interviews as Topic
03 medical and health sciences
0302 clinical medicine
All institutes and research themes of the Radboud University Medical Center
Electric Power Supplies
Non-physician clinicians
Medical licentiates
medicine
Humans
030212 general & internal medicine
Competence (human resources)
Qualitative Research
media_common
Teamwork
Remote Consultation
lcsh:R5-920
030503 health policy & services
lcsh:Public aspects of medicine
Communication
Research
Public Health
Environmental and Occupational Health
Health services research
lcsh:RA1-1270
Task shifting
medicine.disease
Hospitals
District
Telemedicine
3. Good health
Global surgery
lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4]
Equipment and Supplies
Surgical Procedures
Operative
Workforce
Business
Medical emergency
Clinical Competence
Rural Health Services
Thematic analysis
0305 other medical science
lcsh:Medicine (General)
Zdroj: Human Resources for Health
Human Resources for Health, 18
Human Resources for Health, Vol 18, Iss 1, Pp 1-8 (2020)
Human Resources for Health, 18, 1
ISSN: 1478-4491
Popis: IntroductionMany 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.MethodsTwenty-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.ResultsInterviewees 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.ConclusionThis 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.
Databáze: OpenAIRE
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