Uganda Sees Gaps in Medical Skills

The Makerere University College of Health Sciences has responded to an acute shortage of surgeons by training auxillary health workers.

These have included nurses and medical officers. During a recent training stint, the project team leader Prof. Sam Luboga, a lecturer in the Department of Anatomy at the School of Biomedical Science said, the implications of this shortage are far-reaching.

He said, “There is limited access to life-saving surgical services in Uganda and yet there is heavy surgical workload ranging from high maternal mortality rate, high case fatality rate for injuries and other surgical emergencies.”

Professor Luboga said a situation analysis for the project was done in 25 hospitals and it was found there was a desire among medical officers for surgical skills.

He said this demand was demonstrated by the participation of the health workers in Essential Surgical Skills training workshops which will be followed up by mentoring of medical officers and their surgical teams in Essential and Emergency Surgery.

“We expect that this will increase output and therefore make better use of available human resource, make use of redundant theatres, improve access and reduce mortality rate and disability attributable to surgically treatable conditions,” he said.

He said the project will focus on the use of Task Shifting to expand the provision of essential surgical services, with the ultimate aim of increasing access to high quality lifesaving surgical care by among other activities piloting a training program for non-surgeon physicians (NSPs) amp non-physician clinicians (NPCs).

He said, “Some of the questions the project will be answering include how we can improve access to quality emergencyessential surgery for the people of Uganda given shortage of surgeons and how to improve the productivity and quality of outcome of surgery at General Hospitals and Health Centre.”

Evidence available shows that in Uganda, general hospitals and Health Centre IVs already do carry out surgical operations. These are carried out by non-surgeon physicians and non-physician clinicians without appropriate training.

“In a survey of nine hospitals in 2008, we documented that surgical output had not changed over the past ten years. The average number of operations was 3 per day. The causes of such a low output include human resource shortages and capacity.” Luboga said.

The expected benefits of this initiative for Ugandans at different levels include save of lives lost due to unrelieved obstructed labour, intestinal obstruction, road traffic accidents, prevention of disabilities due to essential surgeries not done, among others.

The project will be piloted in 25 districts of Uganda, including Mukono, Mityana, Mubende, Masaka, Bugiri, Rakai, Iganga, Mpigi, Kayunga, Lyantonde, Kiboga, Nakaseke, Wakiso, Luwero, Jinja and Serere.

While Sub Saharan Africa takes 25% of the global disease burden, it only has 3% of the global health workforce. In the case of surgery in East Africa, there are 0.25 fully trained surgeons per 100,000 persons compared to 5.69 surgeons per 100,000 persons in the United States. This means, there is a quarter of a surgeon to serve 100,000 people for Uganda.

Source : East African Business Week

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