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Scaling up Access to Emergency Surgery in Uganda: Meeting the Human Resource Gap

Scaling up Access to Emergency Surgery in Uganda: Meeting the Human Resource Gap. Doruk Ozgediz, MD MSc 1 , Olga Bornemisza MSc 2 , Charles Hongoro PhD 2 , Jackson Amone MD MSc 3 , Diana Farmer MD 3 , Haile Debas MD 3 1 Global Health Sciences and the Department of Surgery, UCSF

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Scaling up Access to Emergency Surgery in Uganda: Meeting the Human Resource Gap

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  1. Scaling up Access to Emergency Surgery in Uganda: Meeting the Human Resource Gap Doruk Ozgediz, MD MSc1, Olga Bornemisza MSc2, Charles Hongoro PhD2, Jackson Amone MD MSc3, Diana Farmer MD3, Haile Debas MD3 1 Global Health Sciences and the Department of Surgery, UCSF 2 Health Policy Unit, London School of Hygiene and Tropical Medicine 3 Department of Clinical Services, Ministry of Health, Republic of Uganda

  2. Surgery in Developing Countries • 90% of global surgical need • Poor access to care • 50% of Global Burden of Disease • Cost-effectiveness • Emergency Obstetric Care • Trauma • Cataracts

  3. Uganda: Health Care • 25 million population • 80-90% rural, hard to reach areas • Total Health expenditure/capita $18 • WHO $34/capita • USA $5000/capita • Declining HIV prevalence • Conflict in the north: 2 million IDP’s

  4. Health Systems/Services Research:An Economic Model • Supply • Human Resources • Infrastructure • Demand • Transport cost • Gender • Cultural beliefs

  5. New Policy: Emergency Surgery in Ugandan Subdistricts • Decentralization • National Health Policy (1999) • 214 Health Subdistricts • 139 (65%) HC4’s required upgrading • Equity: “Services closer to the people” • Emergency Obstetric Care and MDG’s • Trauma • Cost-effective?

  6. Uganda Health Infrastructure

  7. Hypothesis • There are significant human resource constraints to scaling up surgery at the subdistrict level in Uganda

  8. Methods • Literature review • Semi-structured in-depth interviews • Thematic analysis • Site visits

  9. Results: SurgicalWorkforce Constraints • Staffing • Production • Migration • Skills • Clinical • Management • Solutions

  10. Staffing: Production • 150 physicians/year • MD:population ratio 1: 12-25,000 • 100 general surgeons/total; 20 orthopedic • 26% of HC4 no medical officer • Solution: Surgical paramedics

  11. Staffing: Migration • Brain drain: 30% of new doctors migrate abroad • Solution: Improved pay • Solution: Develop research/training capacity

  12. Clinical Skills • Young physicians out of internship • Solution: Senior staff • Not enough training or regularity of practice • Solution: Surgical camps • Solution: Integrating ES curriculum or rural surgery curriculum into training

  13. Management Skills • Budgets, Admin, Supervision • Solution: separate cadre • Overwhelm clinical responsibilities • Solution: second medical officer • Solution: shifting personnel from hospitals

  14. Conclusions and Areas ofFurther Research • Multi-level HR constraints • Evidence base of strategies • Training, Distribution of Manpower • Decentralization with limited resources • Cost-effectiveness vs. equity • Consider integration of trauma training with emergency surgery • Surgery/Trauma care as an essential population-based intervention

  15. Thank You

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