Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #109493

Doruk Ozgediz, MD, MSc¹, Olga Bornemisza, MEDes, MSc², Charles Hongoro, PhD², Jackson Amone, MD, MSc³, Diana L. Farmer, MD⁴, and Haile Debas, MD⁴. (1) Department of Surgery, University of California, San Francisco, 530 Parnassus, Surgery Resident Office S-343, San Francisco, CA 94143, 4154761239, dozgediz@hotmail.com, (2) Health Policy Unit, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom, (3) Department of Clinical Services, Ministry of Health, Republic of Uganda, PO Box 7272, Kampala, Uganda, (4) Global Health Sciences and Department of Surgery, Division of Pediatric Surgery, University of California, San Francisco, 530 Parnassus, San Francisco, CA 94143

Surgery as a discipline has not traditionally been considered as a component of the public health arena despite evidence of significant mortality and morbidity imposed by treatable surgical conditions in developing countries. Human resource requirements impede the provision of surgical services in developing countries. Uganda is implementing an ambitious plan to scale-up access to emergency surgery at its subdistrict level. The surgical human resource constraints of this policy were investigated through site visits to Ugandan subdistrict health centers and in-depth targeted interviews with selected stakeholders in Uganda including policy-makers, medical and surgical training faculty, international donors, district directors of health services, and district health service personnel. A comprehensive literature review of surgery in developing countries was also conducted.

Multiple levels of human resource constraints were identified, including adequate numbers of staff, mix of skills, recruitment and retention in rural areas, and Uganda's decentralized context and finance of health care. Strategies adopted in Uganda to overcome these constraints include increased staffing in peripheral health units, decentralization of medical education, rural hardship allowances, greater training in emergency surgery, and surgical camps. Other developing countries have managed by training paramedical surgical personnel, developing a specialized rural surgery curriculum, telemedicine programs, and through innovative finance mechanisms. Local capacity-building in science and medicine may be a long-term solution to decrease migration of health workers abroad.

These initial observations combined with the future outcomes of proposed and ongoing solutions derived in Uganda can provide lessons for other developing countries with limited resources trying to scale-up access to emergency surgery.

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