Assessment of Essential Emergency surgical care in Karnali Province

Abstract

Introduction: As the overwhelming surgical burden of injury and disease steadily increases worldwide, disproportionately affecting low- and middle-income countries, adequate surgical and trauma care systems are essential. Little is known about the emergency and essential surgical care (EESC) capacity of facilities in Karnali province of nepal. The objective of this study was to assess the EESC capacity in  hospitals across province.

Methodology: This cross-sectional survey used the WHO Tool for Situational Analysis to Assess EESC, investigating key areas i.e. : infrastructure, human resources, interventions, and equipment and supplies. Ten hospitals of province weresurveyed between May 2020 to April 2021. Facilities were conveniently sampled,questionnaires were completed by local staff, and one of us (L.S.) either confirmed the data by on-site inspection or by telephone interview of key hospital personnel.

Results: Ten government hospitals and health centers (district and tertiary level) were assessed,represent most of the major health facilities  of the Karnali province. A total of 11 physicians currently do the majority of the surgery in district hospitals , with the assistance of 7 paramedical staff and only 6 midwives to assist with obstetrics. Anesthesia is administered by 11 nurse anesthetists and 3 non specialist physician . Among 28 procedures performed , all 10  facilities (100%) reported performing removal of foreign body , Acute burn management, incision and drainage of abscesses, suturing, wound debridement , dilatation and curettage . None of facilities had cleft lip repair service. Emergency Cesarean section and joint dislocation treatment  being managed by 9 facilities(90%) . Basic supplies and equipment of the facilities are severely limited

Conclusion:  Emergency and Essential Surgical Care is severely limited due to poor physical infrastructure, lack of qualified human resources, and anesthesia equipment’s.. To achieve health for all Strategy and delivery of the Basic lifesaving  Services, Optimization of resources and manpower are needed to improve surgical and anesthetic care.