Sugical Quality and Task-Shifting in Sub Saharan Africa

Globally, five billion people cannot access safe and affordable surgical care when needed. Every year, one and a half million deaths can be avoided if safe essential and emergency surgical care would have been available. Shortage of health care staff is considered the main reason for the extensive unmet need for surgery. Sierra Leone has one of the highest maternal mortality ratios in the world, with 11 mothers dying of pregnancy related complications, for every 1000 live born babies. Many of these deaths could have been avoided if emergency obstetric and surgical services would have been available. One possibility to improve access to essential obstetric and surgical care is to train non-physicians clinicians (health workers with a level of basic medical training between a doctor and a nurse). Transferring surgical tasks from specialists to non-specialists is an innovative approach called surgical task-sharing. To date, there are few studies that have examined the safety of this increasingly applied solution for the expansion of surgical health care workers. Surgical task-sharing will only be beneficial if quality of care is maintained. The aim of this project is to assess quality of surgical care in Sierra Leone and examine differences in mortality and morbidity after caesarean sections performed by medical doctors and non-physician clinicians. Other related areas that the will be examined are: risk factors for postoperative mortality, long-term (1 and 5 year) outcomes, catastrophic health expenditure and women’s experience. Before the start of the study in October 2016, the anesthesia teams in the 9 participating hospitals were trained to do the inclusion and the in-hospital data-collection. In addition, three research nurses were trained to conduct home visits and supervise the data collection process in the hospitals. Between October and December 2016 more than 400 patients, of the planned 1200 patients, were included in the study. More than 200 home visits were conducted including semi-structured in-depth interviews to assess women’s experience in relation to caesarean section. The planned number of 1200 inclusion is expected to be reached in May or June 2017.