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Emergency and surgery services of primary hospitals in the United Republic of Tanzania
  1. Tom Penoyar1,
  2. Hillary Cohen2,
  3. P Kibatala3,
  4. A Magoda4,
  5. G Saguti3,
  6. L Noel5,
  7. S Groth5,
  8. D H Mwakyusa6,
  9. M Cherian5
  1. 1Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  2. 2Maimonides Medical Center, Brooklyn, New York, USA
  3. 3WHO Country Office, Dar es Salaam, United Republic of Tanzania
  4. 4St Francis Designated District Hospital, Ifakara, United Republic of Tanzania
  5. 5Emergency & Essential Surgical Care program, Department Essential Health Technologies, WHO, Geneva, Switzerland
  6. 6Ministry of Health and Social Welfare, United Republic of Tanzania
  1. Correspondence to Dr Tom Penoyar; tpenoyar{at}bidmc.harvard.edu

Abstract

Objective The primary objective was to evaluate the capacity of first-referral health facilities in Tanzania to perform basic surgical procedures. The intent was to assist in planning strategies for universal access to life-saving and disability-preventing surgical services.

Design Cross-sectional survey.

Setting First-referral health facilities in the United Republic of Tanzania.

Participants 48 health facilities.

Measures The WHO Tool for Situational Analysis to Assess Emergency and Essential Surgical Care was employed to capture a health facility's capacity to perform basic surgical (including obstetrics and trauma) and anaesthesia interventions by investigating four categories of data: infrastructure, human resources, interventions available and equipment. The tool queried the availability of eight types of care providers, 35 surgical interventions and 67 items of equipment.

Results The 48 facilities surveyed served 18.6 million residents (46% of the population). Supplies for basic airway management were inconsistently available. Only 42% had consistent access to oxygen, and only six functioning pulse oximeters were located in all facilities surveyed. 37.5% of facilities reported both consistent running water and electricity. While very basic interventions (suturing, wound debridement, incision and drainage) were provided in nearly all facilities, more advanced life-saving procedures including chest tube thoracostomy (30/48), open fracture management (29/48) and caesarean section delivery (32/48) were not consistently available.

Conclusions Based on the results in this WHO country survey, significant gaps exist in the capacity for emergency and essential surgical services in Tanzania including deficits in human resources, essential equipment and infrastructure. The information in this survey will provide a foundation for evidence-based decisions in country-level policy regarding the allocation of resources and provision of emergency and essential surgical services.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

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Footnotes

  • To cite: Penoyar T, Cohen H, Kibatala P, et al. Emergency and surgery services of primary hospitals in the United Republic of Tanzania. BMJ Open 2012;2:e000369. doi:10.1136/bmjopen-2011-000369

  • Contributors TP analysed and interpreted the data, drafted the article, revised it and finally approved the submitted version. HC contributed to conception and design, acquisition and interpretation of data, made critical revisions and finally approved the submitted version. PK contributed to acquisition of data, made critical revisions and finally approved the submitted version. AM contributed to acquisition of data, made critical revisions and finally approved the submitted version. GS contributed to acquisition of data, made critical revisions and finally approved the submitted version. LN contributed to conception and design, interpretation of data, made critical revisions and finally approved the submitted version. SG contributed to conception and design, interpretation of data, made critical revisions and finally approved the submitted version. DHM contributed to acquisition of data, made critical revisions and finally approved the submitted version. MC contributed to conception and design, acquisition and interpretation of data, helped draft the article, made critical revisions and finally approved the submitted version.

  • Funding None.

  • Disclaimer The authors include staff members of WHO. They are responsible for the views expressed in this publication and do not necessarily represent the decisions or stated policy of WHO.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available, all has been included.

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