ArticleGlobal health research and policy2019
Understanding surgical care delivery in Sub-Saharan Africa: a cross-sectional analysis of surgical volume, operations, and financing at a tertiary referral hospital in rural Tanzania.
Article in Global health research and policy, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Resource use, availability and cost in the provision of critical care in Tanzania: a systematic review.BMJ open · 2022Pooled it
- Global challenges and perspectives in acute and emergency general surgery in low and middle-income countries: a scoping review.BMJ global health · 2026Article
- Epidemiology, outcomes, and access to care for pediatric patients who underwent surgery in Northern Tanzania: A cross-sectional study.PLOS global public health · 2025Article
- The Role of Telemedicine in Enhancing Surgical Care Delivery in Africa: A Literature Review.Health science reports · 2024Article
- Reaching consensus on factors impacting optimal use of an orthopaedic emergency theatre in a public hospital.Health SA = SA Gesondheid · 2024Article
- A Journey Undertaken by Families to Access General Surgical Care for their Children at Muhimbili National Hospital, Tanzania; Prospective Observational Cohort Study.World journal of surgery · 2022Observational
- The burden of orthopaedic disease presenting to a tertiary referral center in Moshi, Tanzania: a cross-sectional study.The Pan African medical journal · 2022Article
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- Prevalence and factors associated with cancellation and deferment of elective surgical cases at a rural private tertiary hospital in Western Uganda: a cross-sectional study.The Pan African medical journal · 2021Article
- Definitive surgical femur fracture fixation in Northern Tanzania: implications of cost, payment method and payment status.The Pan African medical journal · 2021Article
- Construction of Rural Financial Organization Spatial Structure and Service Management Model Based on Deep Convolutional Neural Network.Computational intelligence and neuroscience · 2021Article
- Root causes of elective surgical case cancellation in Ethiopia: a systematic review and meta-analysis.Patient safety in surgery · 2020Article
- Financial Risk Protection and Hospital Admission for Trauma in Cameroon: An Analysis of the Cameroon National Trauma Registry.World journal of surgery · 2020Article
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAccess to surgical care in Low- and Middle-Income Countries (LMICs) such as Tanzania is extremely limited. Northern Tanzania is served by a single tertiary referral hospital, Kilimanjaro Christian Medical Centre (KCMC). The surgical volumes, workflow, and payment mechanisms in this region have not been characterized. Understanding these factors is critical in expanding access to healthcare. The authors sought to evaluate the operations and financing of the main operating theaters at KCMC in Sub-Saharan Africa.
methodsThe 2018 case volume and specialty distribution (general, orthopaedic, and gynecology) in the main operating theaters at KCMC was retrieved through retrospective review of operating report books. Detailed workflow (i.e. planned and cancelled cases, lengths of procedures, lengths of operating days) and financing data (patient payment methods) from the five KCMC operating theater logs were retrospectively reviewed for the available five-month period of March 2018 to July 2018. Descriptive statistics and statistical analysis were performed.
resultsIn 2018, the main operating theaters at KCMC performed 3817 total procedures, with elective procedures (2385) outnumbering emergency procedures (1432). General surgery (1927) was the most operated specialty, followed by orthopaedics (1371) and gynecology (519). In the five-month subset analysis period, just 54.6% of planned operating days were fully completed. There were 238 cancellations (20.8% of planned operations). Time constraints (31.1%, 74 cases) was the largest reason; lack of patient payment accounted for as many cancellations as unavailable equipment (6.3%, 15 cases each). Financing for elective theater cases included insurance 45.5% (418 patients), and cash 48.4% (445 patients).
conclusionWhile surgical volume is high, there are non-physical inefficiencies in the system that can be addressed to reduce cancellations and improve capacity. Improving physical resources is not enough to improve access to care in this region, and likely in many LMIC settings. Patient financing and workflow will be critical considerations to truly improve access to surgical care.
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