Status of surgical activity in Sierra Leone in 2012

Results from a country wide survey

Håkon A. Bolkan

Chairman – CapaCare

19. June 2014

The project

Baseline study - Aim

1. Establish a baseline for surgical and obstetrical activity in Sierra Leone in 2012

2. Comprehensive mapping of nationwide major surgical activity

3. Identify training resources (Hosp/organisations)

Bolkan, et al - Submitted 2014

Facilities performing one or more of the comprehensive surgical procedures listed in

the WHO used Service and Readiness Assessment (SARA) tool.

Methodology - selection of institutions (1)

Selection of institutions (2)

Methodology - process

• Data collection January – May 2013• Medical students• Source of data

– Operation Theatre Logbooks– Delivery log books– Anesthesia log books

Duplicates removed

Results

Major surgeries in SL in 2012: 24 152

Results:Nationwide Surgical volume by district and sector

N = 24 152

Major surgeries/100 000 population

Weste

rn A

rea

Port Lo

ko

Bombali Bo

TonkoliliKono

Kenema

Kailahun

Koinadugu

Pujehun

Bonthe

Kambia

Moyamba

0

100

200

300

400

500

600

700

800

900

1000

National average

X 30

Surgical activity by sector54,0% 39,6% 6,4%

Results

Surgical HR

1. Full Time Equivalent (FTE)2. Only staff performing surgery counted

Surgical HR - Who

35%

53%

4% 8%

Distribution of surgical providers

ConsultantMedical DoctorNurseAssociate Clinician

Consultant Medical Doctor Nurse Associate Clinician Total

n % n % n % n % n %

58,5 35,4 % 87,0 52,6 % 6,2 3,7 % 13,8 8,3 % 165,4

HR – FTE per provider and sector

Distribution of surgical providers

 

Consultant Medical Doctor Nurse Associate Clinician Total

n % n % n % n % n %

Governmental 21,3 36,3 % 50,1 57,6 % 2,0 32,4 % 3,0 21,8 % 76,3 46,2 %

Private For Profit 12,8 21,9 % 4,3 5,0 % 0,1 1,4 % 3,0 21,8 % 20,2 12,2 %

Private Non Profit 24,4 41,7 % 32,6 37,5 % 4,1 66,2 % 7,8 56,4 % 68,8 41,6 %

Total 58,5 35,4 % 87,0 52,6 % 6,2 3,7 % 13,8 8,3 % 165,4  

Consultant Medical Doctor Nurse Associate Clinician0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Private Non ProfitPrivate For ProfitGovernmental

HR – Surgical activity by healthcare provider and sector

Distribution of surgical providers

Associate Clin-ician

Consultant Obstetrician

Consultant Surgeon

Medical Doctor

Nurse Unknown0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Private Non ProfitPrivate For ProfitGovernmental

HR – Surgical activity by healthcare provider nationality and sector

Distribution of surgical providers

Associa

te Clin

ician

Consulta

nt Obste

tricia

n

Consulta

nt Surg

eon

Medica

l Docto

rNurse

Unknown0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

UnknownForeignDomestic

Distribution of surgical providers

Bo

Bombali

Kailahun

Kambia

Kenema

KoinaduguKono

Moyamba

Port Lo

ko

Pujehun

Tonkolili

Weste

rn A

rea

0

1

2

3

4

5

6

7

8

9

Accumulate surgical provider density by 100 000 population

Associate Clinician

Nurse

Medical Doctor

Consultant

Bo

Bombali

Bonthe

Kailahun

Kambia

Kenema

KoinaduguKono

Moyamba

Port Lo

ko

Pujehun

Tonkolili

Weste

rn A

rea

0

100

200

300

400

500

600

700

800

900

1000

Major surgical procedures by 100 000 population

Conclusion

1. Large unmet need for major surgery in Sierra Leone

2. Large discrepancies between urban and rural areas

3. Physician constrains in District hospitals

4. Private Non Profit is a major surgical service provider

5. Surgery and obstetrics – developed as one service

Aim: Increase surgical capacity and activity in Sierra Leone

2011 2013 2014 2015 20162012 2017

Training program

Baseline study - Nationwide

Service provision

Goal: 30

Goal: 100% increase

MonitoringQuality DH

Training Housemanship

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