Changes in surgical volume, workforce, and productivity in Sierra Leone between 2012 and 2017

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Study Justification:
– The study aimed to assess the changes in surgical activity, surgical workforce, and surgical productivity in Sierra Leone between 2012 and 2017.
– The study is important because it provides valuable information on the progress made in meeting the surgical targets set by the Lancet Commission on Global Surgery.
– The findings of the study can help identify the gaps and challenges in accessing and delivering surgical care in Sierra Leone.
Highlights:
– The surgical workforce in Sierra Leone increased from 164.5 to 312.8 full-time positions between 2012 and 2017.
– The annual volume of surgeries increased by 15.6% during the same period.
– Despite these improvements, the unmet need for surgery in Sierra Leone remains very high, with an unmet operative need of 92.7%.
– The mean productivity of surgical providers decreased from 2.8 to 1.7 surgeries per week per full-time position.
– The study also highlighted an increasing number of caesarean deliveries performed in public institutions by associate clinicians.
Recommendations:
– Further exploration of the barriers to access and delivery of surgical care in Sierra Leone is needed.
– Strategies should be developed to increase surgical productivity and address the unmet need for surgery.
– Investments should be made to strengthen the surgical workforce and improve surgical infrastructure.
– Training programs should be implemented to enhance the skills of surgical providers and promote task-sharing.
Key Role Players:
– Ministry of Health: Responsible for policy-making and coordination of healthcare services.
– Surgical Specialists: Provide specialized surgical care.
– Facility Directors: Manage and oversee surgical facilities.
– Associate Clinicians: Perform caesarean deliveries in public institutions.
Cost Items for Planning Recommendations:
– Training Programs: Budget for developing and implementing training programs for surgical providers.
– Infrastructure Improvement: Funds for upgrading surgical facilities and equipment.
– Workforce Strengthening: Allocation for recruitment, training, and retention of surgical workforce.
– Task-Sharing Program: Budget for implementing and monitoring a surgical task-sharing program.
– Outreach and Awareness Campaigns: Funds for raising awareness about the importance of surgical care and promoting access to services.

Background: The Lancet Commission on Global Surgery recommends a minimum of 20 surgical specialists and 5,000 annual operations per 100,000 population by 2030. In 2012, Sierra Leone was far from reaching these targets. This study aimed to assess the changes in surgical activity, surgical workforce, and surgical productivity between 2012 and 2017. Methods: A nationwide, retrospective mapping of surgical activity and workforce in 2012 was repeated in 2017. All 60 facilities performing comprehensive surgery in Sierra Leone in 2017 were identified and data was obtained from surgical records and through structured interviews with facility directors. Annual estimates were calculated and compared with 2012. Results: The surgical workforce increased from 164.5 to 312.8 full-time positions. The annual volume of surgeries was enhanced by 15.6% (95% CI: 7.8–23.4%) from 24,152 to 27,928 (26,048–29,808) operations. With simultaneous population growth, this led to a decrease in surgical volume from 400 to 372 procedures per 100,000 population and an unmet operative need of 92.7%. The mean productivity of surgical providers went from 2.8 to 1.7 surgeries per week per full-time position. An increasing number of caesarean deliveries were performed in public institutions, by associate clinicians. Conclusion: The unmet need for surgery in Sierra Leone remains very high, despite an increase in the surgical workforce, subsidizing maternal healthcare, and initiation of a surgical task-sharing program. The decline in surgical productivity with simultaneous increases in the surgical workforce calls for further exploration of the barriers to access and delivery of surgical care in Sierra Leone.

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Based on the provided information, here are some potential recommendations to improve access to maternal health in Sierra Leone:

1. Increase the number of surgical specialists: To meet the recommended target of 20 surgical specialists per 100,000 population by 2030, efforts should be made to recruit and train more surgical specialists in Sierra Leone. This will help ensure that there are enough skilled professionals to provide maternal health services.

2. Improve surgical productivity: The decline in surgical productivity, as indicated by the decrease in surgeries per week per full-time position, needs to be addressed. Strategies such as optimizing workflow, implementing efficient surgical protocols, and providing adequate resources and support to surgical providers can help improve productivity.

3. Strengthen surgical task-sharing programs: The study mentioned the initiation of a surgical task-sharing program, which involves training associate clinicians to perform certain surgical procedures. This program should be further developed and expanded to increase the number of healthcare providers who can perform cesarean deliveries and other essential maternal health surgeries.

4. Enhance access to surgical facilities: Efforts should be made to ensure that surgical facilities are accessible to all women in Sierra Leone, especially those in remote or underserved areas. This may involve improving transportation infrastructure, establishing satellite surgical clinics, or implementing telemedicine solutions to provide remote consultations and support.

5. Increase public investment in maternal healthcare: Adequate funding and resources should be allocated to maternal healthcare services, including surgical interventions. This can help subsidize the cost of surgeries, making them more affordable and accessible to women in need.

6. Address barriers to access: Further exploration of the barriers to access and delivery of surgical care is necessary. This may involve conducting research, engaging with communities, and collaborating with stakeholders to identify and address factors such as cultural beliefs, lack of awareness, and logistical challenges that prevent women from accessing maternal health services.

It is important to note that these recommendations are based on the provided study and may need to be further evaluated and tailored to the specific context and needs of Sierra Leone.
AI Innovations Description
Based on the information provided, the study conducted in Sierra Leone highlights the need for further improvement in access to maternal health. Here is a recommendation that can be developed into an innovation to address this issue:

Recommendation: Implement a comprehensive maternal health program that focuses on increasing access to safe and timely surgical interventions for pregnant women in Sierra Leone.

Explanation:

1. Strengthen Surgical Workforce: Invest in training and recruiting more surgical specialists to meet the recommended target of 20 surgical specialists per 100,000 population by 2030. This will help increase the availability of skilled professionals to perform necessary surgical procedures during childbirth.

2. Enhance Surgical Productivity: Develop strategies to improve the productivity of surgical providers, such as implementing efficient surgical protocols, optimizing workflow, and providing necessary resources and equipment. This will help increase the number of surgeries performed per week per full-time position, ensuring that more women receive the required surgical interventions.

3. Expand Access to Surgical Facilities: Increase the number of facilities equipped to perform comprehensive surgery, particularly in rural areas where access to maternal healthcare is limited. This can be achieved by establishing satellite surgical centers or mobile surgical units that can reach remote communities.

4. Strengthen Surgical Task-Sharing Program: Continue and expand the surgical task-sharing program, which allows associate clinicians to perform caesarean deliveries in public institutions. This will help alleviate the burden on surgical specialists and increase the availability of surgical interventions for pregnant women.

5. Improve Data Collection and Monitoring: Implement a robust data collection and monitoring system to track surgical activity, workforce, and productivity. This will provide valuable insights into the effectiveness of the implemented interventions and help identify areas for further improvement.

By implementing these recommendations, Sierra Leone can make significant progress in improving access to maternal health and reducing the unmet need for surgical interventions during childbirth.
AI Innovations Methodology
Based on the provided description, it seems that the focus is on assessing the changes in surgical activity, workforce, and productivity in Sierra Leone between 2012 and 2017. However, the request is to consider innovations for potential recommendations to improve access to maternal health and describe a methodology to simulate the impact of these recommendations on improving access to maternal health.

To address this, here are some potential innovations and a methodology to simulate their impact on improving access to maternal health:

1. Telemedicine and Teleconsultations: Implementing telemedicine and teleconsultations can improve access to maternal health by allowing remote consultations between healthcare providers and pregnant women. This can help overcome geographical barriers and provide timely advice and support.

2. Mobile Health (mHealth) Applications: Developing and promoting mHealth applications that provide information, reminders, and guidance on prenatal care, nutrition, and postnatal care can empower women to take control of their own health and access maternal health services more effectively.

3. Community Health Workers: Expanding the role of community health workers in maternal health can improve access by bringing healthcare services closer to the community. These workers can provide education, antenatal care, and postnatal support, and act as a bridge between the community and formal healthcare facilities.

Methodology to simulate the impact of these recommendations:

1. Define the parameters: Identify key indicators to measure the impact of the recommendations, such as the number of teleconsultations conducted, the usage of mHealth applications, and the involvement of community health workers.

2. Data collection: Gather data on the current state of maternal health access, including the number of healthcare facilities, healthcare providers, and maternal health outcomes. Collect data on the potential adoption and utilization of the recommended innovations.

3. Modeling and simulation: Use mathematical modeling techniques to simulate the impact of the recommendations on improving access to maternal health. This can involve creating scenarios based on different levels of adoption and utilization of the innovations, and estimating the potential increase in access and improvement in maternal health outcomes.

4. Sensitivity analysis: Conduct sensitivity analysis to assess the robustness of the results and identify key factors that influence the impact of the recommendations. This can help prioritize interventions and identify potential barriers or challenges that need to be addressed.

5. Evaluation and refinement: Evaluate the simulated impact against real-world data and refine the model as necessary. Continuously monitor the implementation of the recommendations and update the simulation model accordingly to ensure its accuracy and relevance.

By following this methodology, policymakers and healthcare providers can gain insights into the potential impact of these innovations on improving access to maternal health and make informed decisions on their implementation.

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