Multi-level system assessment of the Ghanaian emergency, trauma, and surgical care system : a roadmap for development

[摘要] ENGLISH SUMMARY : This dissertation is a compilation and evolution of a multi-levelassessment of emergency, trauma and surgical care in Ghana that was designed to provide benchmarking data, identify key gaps, and outline a plan for development.The work began with an assessment of surgical and trauma care capacity at district, regional and tertiary hospitals nationwide. The results demonstrated critical deficiencies in essential resourcesthat limit the quality of care that could be provided to the sick and injured. However, when compared to a similar assessment adecade prior, there were notable improvements, which highlighted the potential for positive change, and identified existing opportunities for capacity building.While this work was being completed, three major movements in global surgery and international health policy were afoot that mandated a better understanding of access to essential surgical and trauma care and evaluation and monitoring of essential surgical and trauma care. Therefore, to stay relevant andcontribute meaningfully to the meta-discussion in global surgery, we set out to pilot the collection and use of these metrics in Ghana. In addition to the assessments of capacity, piloting of thenew metrics was done by: i) enumerating all operations done in the country in one year, ii) describing geospatial access tosurgical care, and iii) modeling the risk of catastrophic expenditure for people who need surgery.During this phase of the work, several findings were noted. First, it seemed that surgical capacity was not directly associated to surgical output, which contrasted with the current assumptionsregarding surgical capacity assessments and capacity building initiatives. Therefore, we set out to examine this relationship with data from the national capacity assessment and surgical enumeration. This study confirmed our suspicions: there was no association between capacity and output. The findings suggestedthat several non-measured factors were important for improving output, such as differential barriers to care, process components (e.g., protocols, policies, emotional infrastructure), and systemcoordination. Therefore, we sought to further characterize these components and develop a system-wide roadmap for emergency, trauma, and surgical care system development. This was done by:developing, piloting and expanding a barriers to care assessment tool; developing context-appropriate audit filters to investigate the trend of process metrics; and developing and piloting theWorld Health Organization (WHO) Emergency Care System Assessment Tool (ECSAT) in Ghana.The data from the entire work allowed for a rich description of the state of emergency, trauma, and surgical care in the country, identification of the key gaps, and creation of a roadmap fordevelopment. The latter was done in conjunction with the Ghana Ministry of Health and was turned over to them forimplementation and monitoring by in-country partners. The work in total demonstrated the utility of multi-level assessments in planning for strategic development of the healthcare system, and contributed meaningfully to the global surgery movement with regards to tool creation and piloting of several novel metrics.

[发布机构] Stellenbosch University