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Human Resources for Health

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01-12-2020 | Research

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

Authors: Jakub Gajewski, Nasser Monzer, Chiara Pittalis, Leon Bijlmakers, Mweene Cheelo, John Kachimba, Ruairi Brugha

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

Abstract

Introduction

Many 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.

Methods

Twenty-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.

Results

Interviewees 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.

Conclusion

This 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.

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Title: Supervision as a tool for building surgical capacity of district hospitals: the case of Zambia
Authors: Jakub Gajewski
Nasser Monzer
Chiara Pittalis
Leon Bijlmakers
Mweene Cheelo
John Kachimba
Ruairi Brugha
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/s12960-020-00467-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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