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Human Resources for Health

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Open Access 01-12-2020 | Review

Barriers to surgery performed by non-physician clinicians in sub-Saharan Africa—a scoping review

Authors: Phylisha van Heemskerken, Henk Broekhuizen, Jakub Gajewski, Ruairí Brugha, Leon Bijlmakers

Published in: Human Resources for Health | Issue 1/2020

Abstract

Background

Sub-Saharan Africa (SSA) faces the highest burden of disease amenable to surgery while having the lowest surgeon to population ratio in the world. Some 25 SSA countries use surgical task-shifting from physicians to non-physician clinicians (NPCs) as a strategy to increase access to surgery. While many studies have investigated barriers to access to surgical services, there is a dearth of studies that examine the barriers to shifting of surgical tasks to, and the delivery of safe essential surgical care by NPCs, especially in rural areas of SSA. This study aims to identify those barriers and how they vary between surgical disciplines as well as between countries.

Methods

We performed a scoping review of articles published between 2000 and 2018, listed in PubMed or Embase. Full-text articles were read by two reviewers to identify barriers to surgical task-shifting. Cited barriers were counted and categorized, partly based on the World Health Organization (WHO) health systems building blocks.

Results

Sixty-two articles met the inclusion criteria, and 14 clusters of barriers were identified, which were assigned to four main categories: primary outcomes, NPC workforce, regulation, and environment and resources. Malawi, Tanzania, Uganda, and Mozambique had the largest number of articles reporting barriers, with Uganda reporting the largest variety of barriers from empirical studies only. Obstetric and gynaecologic surgery had more articles and cited barriers than other specialties.

Conclusion

A multitude of factors hampers the provision of surgery by NPCs across SSA. The two main issues are surgical pre-requisites and the need for regulatory and professional frameworks to legitimate and control the surgical practice of NPCs.

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Title: Barriers to surgery performed by non-physician clinicians in sub-Saharan Africa—a scoping review
Authors: Phylisha van Heemskerken
Henk Broekhuizen
Jakub Gajewski
Ruairí Brugha
Leon Bijlmakers
Publication date: 01-12-2020
Publisher: BioMed Central
Published in: Human Resources for Health / Issue 1/2020
Electronic ISSN: 1478-4491
DOI: https://doi.org/10.1186/s12960-020-00490-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Barriers to surgery performed by non-physician clinicians in sub-Saharan Africa—a scoping review

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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