Provision of surgical care in Ethiopia: Challenges and solutions

ABSTRACT

With the lowest measured rate of surgery in the world, Ethiopia is faced with a number of challenges in providing surgical care. The aim of this study was to elucidate challenges in providing safe surgical care in Ethiopia, and solutions providers have created to overcome them. Semi-structured interviews were conducted with 10 practicing surgeons in Ethiopia. Following de-identification and immersion into field notes, topical coding was completed with an existing coding manual. Codes were adapted and expanded as necessary, and the primary data analyst confirmed reproducibility with a secondary analyst. Qualitative analysis revealed topics in access to care, in-hospital care delivery, and health policy. Patient financial constraints were identified as a challenge to accessing care. Surgeons were overwhelmed by patient volume and frustrated by lack of material resources and equipment. Numerous surgeons commented on the inadequacy of training and felt that medical education is not a government priority. They reported an insufficient number of anaesthesiologists, nurses, and support staff. Perceived inadequate financial compensation and high workload led to low morale among surgeons. Our study describes specific challenges surgeons encounter in Ethiopia and demonstrates the need for prioritisation of surgical care in the Ethiopian health agenda.

Abbreviations: LCoGS: The Lancet Commission on Global Surgery; LMIC: low- and middle-income country

KEYWORDS:

• Ethiopia
• global surgery
• surgery
• patient access
• anaesthesia

Acknowledgements

We thank Leyouget Abebe, RN, who assisted with interviewing participants. We would also like to thank The Lancet Commission on Global Surgery, and the Surgical Society of Ethiopia. N Starr and CM Kelly underwent training with the implementation manual, conducted interviews, created field notes, and wrote the manuscript. NP Raykar created the implementation manual and interview guide, assisted with data coding and analysis, and discussed summarised data with interviewers. RR Yorlets coded, analyzed, and summarised data. C Liu coordinated the project with the interviewers and discussed summarised data with interviewers. M Derbew oversaw the project in Ethiopia and assisted with purposive sampling. All authors provided critical revisions to the manuscript and approved its final version.

Disclosure statement

No potential conflict of interest was reported by the authors.