Scaling up essential surgery in rural Africa: outcomes of a novel regional initiative

Abstract

Introduction: South Sudan, like most of rural Africa, has a high surgical disease burden and profound unmet surgical needs. This is against a background of weak surgical service delivery systems, especially in the harder-to-reach areas. Here it is further fueled by armed conflict and poverty. The surgical service delivery models applied so far have not adequately improved surgical care. Through the Intergovernmental Authority on Development Regional Initiative for Capacity Building, a surgical team was deployed to Kuajok Hospital in Warrap state. The team mentored South Sudanese health workers for 2 years while working together with other agencies operating in the locality to improve surgical services. This paper is an account of the capacity building process for surgical service improvement at this site, from 2015 to 2017. Methods: A descriptive study of activities and patients seen over a 2-year period at this centre. Quantitatively, statistics were extracted and compiled from all areas of surgical care, including profiles of the various surgical conditions. Qualitatively, information was gathered through unstructured interviews. Results: There was a drastic increase in surgical outpatient consultations, admissions, and operations. There was an improvement in the level of surgical care and patient care systems. New facilities like operating theaters, emergency rooms, surgical consultation rooms, and surgical wards were established. Community attitude and health-seeking behavior improved, leading to improved access to care. An indirect financial benefit was experienced due to improved patient care outcomes and reduced expenditure on referrals. Conclusion: Improvement of surgical services in Africa’s hard-to-reach areas is readily attainable through partnerships and mentoring of native medical workers by personnel from fellow African countries.