The state of surgery, obstetrics, trauma, and anaesthesia care in Ghana: a narrative review

ABSTRACT

Background

Conditions amenable to surgical, obstetric, trauma, and anaesthesia (SOTA) care are a major contributor to death and disability in Ghana. SOTA care is an essential component of a well-functioning health system, and better understanding of the state of SOTA care in Ghana is necessary to design policies to address gaps in SOTA care delivery.

Objective

The aim of this study is to assess the current situation of SOTA care in Ghana.

Methods

A situation analysis was conducted as a narrative review of published scientific literature. Information was extracted from studies according to five health system domains related to SOTA care: service delivery, workforce, infrastructure, finance, and information management.

Results

Ghanaians face numerous barriers to accessing quality SOTA care, primarily due to health system inadequacies. Over 77% of surgical operations performed in Ghana are essential procedures, most of which are performed at district-level hospitals that do not have consistent access to imaging and operative room fundamentals. Tertiary facilities have consistent access to these modalities but lack consistent access to oxygen and/or oxygen concentrators on-site as well as surgical supplies and anaesthetic medicines. Ghanaian patients cover up to 91% of direct SOTA costs out-of-pocket, while health insurance only covers up to 14% of the costs. The Ghanaian surgical system also faces severe workforce inadequacies especially in district-level facilities. Most specialty surgeons are concentrated in urban areas. Ghana’s health system lacks a solid information management foundation as it does not have centralized SOTA databases, leading to incomplete, poorly coded, and illegible patient information.

Conclusion

This review establishes that surgical services provided in Ghana are focused primarily on district-level facilities that lack adequate infrastructure and face workforce shortages, among other challenges. A comprehensive scale-up of Ghana’s surgical infrastructure, workforce, national insurance plan, and information systems is warranted to improve Ghana’s surgical system.

KEYWORDS:

• Ghana
• global surgery
• health system strengthening
• National Surgical Obstetrics and Anaesthesia Plan
• policy analysis

Responsible Editor

Julia Schröders

Responsible Editor

Julia Schröders

Acknowledgments

We are grateful to the reviewers who thoroughly reviewed the manuscript and provided constructive feedback to the authors.

Author contributions

DTJ and USK conceived the study and drafted the manuscript. DTJ, EA, PB, MX, SS, and EN extracted the data. All the authors analysed, critically reviewed, edited, and approved the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Paper context

In Ghana, poor access to quality surgical, obstetric, trauma, and anaesthesia care leads to high mortality and disability rates. While there have been several individual studies assessing the surgical system in Ghana, none have systematically and holistically assessed the entire surgical system. This study provides a holistic look at the entire surgical system in Ghana, and the information can be used to inform national policies and programs to strengthen the surgical system in Ghana.

Additional information

Funding

This project was unfunded.