Barriers to surgery performed by non-physician clinicians in sub-Saharan Africa—a scoping review

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Barriers to surgery performed by non-physician clinicians in sub-Saharan Africa—a scoping review

JournalHuman Resources for Health
Publication date – Jul – 2020
Authors – Phylisha van Heemskerken, Henk Broekhuizen, Jakub Gajewski, Ruairí Brugha & Leon Bijlmakers
KeywordsBarriers; Non-physician clinicians; Surgical task-shifting
Open access – Yes
SpecialityOther
World region Central Africa, Eastern Africa, Middle Africa, Northern Africa, Southern Africa, Western Africa

Language – English
Submitted to the One Surgery Index on July 26, 2020 at 3:44 am
Abstract:

Background
Sub-Saharan Africa (SSA) faces the highest burden of disease amenable to surgery while having the lowest surgeon to population ratio in the world. Some 25 SSA countries use surgical task-shifting from physicians to non-physician clinicians (NPCs) as a strategy to increase access to surgery. While many studies have investigated barriers to access to surgical services, there is a dearth of studies that examine the barriers to shifting of surgical tasks to, and the delivery of safe essential surgical care by NPCs, especially in rural areas of SSA. This study aims to identify those barriers and how they vary between surgical disciplines as well as between countries.

Methods
We performed a scoping review of articles published between 2000 and 2018, listed in PubMed or Embase. Full-text articles were read by two reviewers to identify barriers to surgical task-shifting. Cited barriers were counted and categorized, partly based on the World Health Organization (WHO) health systems building blocks.

Results
Sixty-two articles met the inclusion criteria, and 14 clusters of barriers were identified, which were assigned to four main categories: primary outcomes, NPC workforce, regulation, and environment and resources. Malawi, Tanzania, Uganda, and Mozambique had the largest number of articles reporting barriers, with Uganda reporting the largest variety of barriers from empirical studies only. Obstetric and gynaecologic surgery had more articles and cited barriers than other specialties.

Conclusion
A multitude of factors hampers the provision of surgery by NPCs across SSA. The two main issues are surgical pre-requisites and the need for regulatory and professional frameworks to legitimate and control the surgical practice of NPCs.

OSI Number – 20595
PMID – 32680526

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