ArticleHuman resources for health2020
Supervision as a tool for building surgical capacity of district hospitals: the case of Zambia.
Article in Human resources for health, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 2 of them syntheses that pooled it.
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Who cites it
8 citing papers in PubMed, 2 syntheses or guidelines pooled it, 17 citations in OpenAlex.
- Medical specialists in LMICs: a systematic review and best-fit framework synthesis of the evidence on their roles and contribution to health systems.BMJ global health · 2026Pooled it
- Tools, frameworks and resources to guide global action on strengthening rural health systems: a mapping review.Health research policy and systems · 2023Pooled it
- Monitoring and evaluation strategies for surgical task-shifting and task-sharing interventions: a scoping review.Human resources for health · 2026Article
- Analysis of District Residency Program in Surgical Specialties at a University Teaching Hospital.Advances in medical education and practice · 2026Article
- Improving the management of open tibia fractures, Malawi.Bulletin of the World Health Organization · 2024Article
- Surgical capacity, productivity and efficiency at the district level in Sub-Saharan Africa: A three-country study.PloS one · 2022Article
- Underutilization of Operative Capacity at the District Hospital Level in a Resource-Limited Setting.The Journal of surgical research · 2021Observational
- Policy options for surgical mentoring: Lessons from Zambia based on stakeholder consultation and systems science.PloS one · 2021Article
Corrections and comments
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Authors and funding
7 authors at 3 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionMany countries in sub-Saharan Africa have adopted task shifting of surgical responsibilities to non-physician clinicians (NPCs) as a solution to address workforce shortages. There is resistance to delegating surgical procedures to NPCs due to concerns about their surgical skills and lack of supervision systems to ensure safety and quality of care provided. This study aimed to explore the effects of a new supervision model implemented in Zambia to improve the delivery of health services by surgical NPCs working at district hospitals.
methodsTwenty-eight semi-structured interviews were conducted with NPCs and medical doctors at nine district hospitals and with the surgical specialists who provided in-person and remote supervision over an average period of 15 months. Data were analysed using 'top-down' and 'bottom-up' thematic coding.
resultsInterviewees reported an improvement in the surgical skills and confidence of NPCs, as well as better teamwork. At the facility level, supervision led to an increase in the volume and range of surgical procedures done and helped to reduce unnecessary surgical referrals. The supervision also improved communication links by facilitating the establishment of a remote consultation network, which enabled specialists to provide real-time support to district NPCs in how to undertake particular surgical procedures and expert guidance on referral decisions. Despite these benefits, shortages of operating theatre support staff, lack of equipment and unreliable power supply impeded maximum utilisation of supervision.
conclusionThis supervision model demonstrated the additional role that specialist surgeons can play, bringing their expertise to rural populations, where such surgical competence would otherwise be unobtainable. Further research is needed to establish the cost-effectiveness of the supervision model; the opportunity costs from surgical specialists being away from referral hospitals, providing supervision in districts; and the steps needed for regular district surgical supervision to become part of sustainable national programmes.
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