Background
Methods
Study Design
Search Strategy and Screening
Data Collection and Screening for Eligibility
Eligibility Criteria
Primary Outcome
Analysis
Results
Domain | Finding | Recommendation |
---|---|---|
Equipment and consumables | 20% of dispensaries, 25% of health centres and 45% of hospitals had minimum surgical equipment for their level. 68% of hospitals had necessary medicines and commodities Half of the facilities performing major surgery have blood transfusion, ultrasound, and X-ray capabilities | Define and procure appropriate equipment and consumables at each level of care |
Blood supply | 71.8–82.9% of blood ordered is unused | Develop and implement guidelines around blood prescribing and usage National blood plan to increase donation and distribution |
Education | 0.31 physician surgeons, obstetricians, and anesthesiologists per 100,000 population of the recommended 20–40 per 100,000 population 39.6% of tracked medical graduates not practicing clinical medicine 41% of practicing doctors located in urban regions | Minimum staffing guidelines to include surgical, anaesthesia and obstetric clinicians. Increase access to training programs Increased sponsorships for internships and residencies. |
Task-shifting practice | Non-obstetric major surgical procedures in Tanzania performed by: 55.8% non-physicianclinicians (NPCs) 28.7% surgical specialists 15.5% medical officers [17] | Define and regulate the role of non-specialist providers Develop supportive supervision networks of non-specialist staff |
Referral system | 70% of over 11,000 patients seen at Muhimbili National Hospital self-referrals | Each region to develop a referral plan including transfer criteria, referral logistics, and community education and outreach. |
Budget allocation | 5.6% of Tanzania’s GDP spent on health in 2014 Budget allocation to surgical care is unknown | Advocate for 15% of GDP health spend as per the Abuja declaration. Track % of health budget spent on surgery Trackcosts for providing surgical care |
Patient expenditure | 27% of health spending was from out-of-pocket expenditure 65.8% of population at risk of catastrophic expenditure from seeking surgical care | Monitor cost of surgical care to the individual patient. Advocate for inclusion of essential surgical anaesthesia and obstetric care as part of national health insurance schemes |
Data collection | National Health Management Information System (HMIS) collects data on a limited number of surgical and anaesthesia indicators, including available workforce by district and region and surgical procedures like caesarean sections | Integrate the NSOAP monitoring and evaluation framework in HMIS to ensure visibility of surgical indicators on the national dashboard |
Service Delivery
Workforce
Infrastructure
Information Management
Financing
Discussion
Service Delivery
Hospital level | Number providing major surgery | Total | Percentage (%) |
---|---|---|---|
Zonal, national, or specialized | 6 | 7 | 86 |
Regional hospitals | 18 | 22 | 82 |
District hospitals | 85 | 85 | 100 |
Health centre | 104 | 586 | 18 |
Dispensary | 72 | 4249 | 2 |
Other or unspecified | 82 | 95 | 86 |