Browsing by Author "Dell, Angela June"

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    Global Surgery - A review of the paediatric surgical workforce in South Africa
    (2018) Dell, Angela June; Numanoglu, Alp; Arnold, Marion
    There is limited data with regard to the available paediatric surgical workforce in South Africa as well as their employment prospects upon completion of their specialisation training. These data are essential in developing a National Surgical Plan to address the burden of surgical disease as well as determining where resource allocation is needed. In addition, specialist paediatric surgeons who are unable to find suitable employment are more likely to emigrate, leading to further collapse of the surgical health care system. This aim of this study was to quantify and analyse the paediatric surgical workforce in South Africa as well as to determine their geographic and sector distribution. This research builds on previous research conducted in the field of general surgery and continues to grow the national database on surgical resource in South Africa. This study involved a quantitative descriptive analysis of all registered specialist as well as training paediatric surgeons in South Africa, and included their demographic data, the geographic location of their practice, as well as the sector in which they work. Quantitative data included their plans for public, private or dual practice once they have completed their specialization training. The results showed 2.6 paediatric surgeons per one million population under 14 years. More than half (69%) were male and the median age was 46.8 years. There were however, more female surgical registrars currently in training. The majority of the paediatric surgical practitioners were found in Gauteng (43%), followed by the Western Cape (26%) and Kwa-Zulu Natal (16%). The majority of specialists reportedly worked in the public sector (40.9%), however this number may have been over-reported as hours spent in public practice were not specified. Interprovincial differences as well as intersectoral differences were marked indicating geographic and socioeconomic maldistribution of paediatric surgeons. The public sector paediatric surgeon density (per million population under 14 years) was 2.4 which fell below the private sector paediatric surgeon density of 9.4. These numbers fell far below developed countries such as the United States, Germany and the Netherlands but the private sector density compared favourably with Ireland and Canada. Access to paediatric surgical care requires an adequate supply of experienced surgeons distributed over a wide geographical area. Additionally, paediatric surgeons require a wide range of ancillary support staff and hospital facilities. Without these resources, surgical access for the most vulnerable of populations is limited. Addressing the maldistribution of paediatric surgical workforce requires concerted efforts to expand existing training posts as well as equipping the remainder of level three hospitals to provide paediatric surgical training.
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    Global surgery - socioeconomic and geographic maldistribution of surgical resources
    (2016) Dell, Angela June; Kahn, Delawir
    Surgery is an indispensable part of any health system and improving access to safe surgery remains a challenge in the developing world. Surgery is emerging as a priority in global health, unfortunately information around the burden of surgical diseases or the available surgical resources is limited. South Africa is an Upper Middle Income Country (UMIC) and currently provides reasonable surgical services, however these services vary across regions, between urban and rural settings, as well as between public and private hospitals. There is no reliable data regarding the available surgical resources in South Africa, namely surgical beds, operating theatres and surgeons. These variables are essential in developing a National Surgical Plan to address the burden of surgical disease, however they are limited in the information they provide they provide regarding surgical capacity and need to be assessed in context with more robust indicators. This aim of this study was to quantify some of the specific surgical resources as identified by the World Health Organization (WHO) and the Lancet Commission. This research will contribute to the growing body of research regarding global surgery in South Africa and attempt to provide an analysis of metrics used to evaluate surgical systems. The research hypothesis was that the surgical resources in South Africa were limited, and that surgeons, theatres and hospital beds per capita are inadequate compared to developed countries and do not meet global recommendations. This involved a descriptive analysis of surgical resources and included the total number of hospitals, of hospital beds, the number of surgical beds, the number of general surgeons (specialist and non-specialist), and the number of functional operating theatres in South Africa. The surgical resources were analysed, both according to province and district, and a comparison was performed based on the population density. A comparison of the public and private facilities was undertaken with regard to the total numbers, as well as per population density. Lastly, a comparison was performed with other high and low income countries around the world. The results showed one hospital per 100 000 population, 186.64 hospital beds, 41.55 surgical beds, 1.78 specialist general surgeons, 2.90 non-specialist general surgeons, and 3.59 operating theatres per 100 000 people in South Africa. These numbers fell far below international recommendations, as well as developed countries such as the United Kingdom (UK) and United States of America (USA). Surgical resources were concentrated in metropolitan areas, and there were differences between the public and private sectors, with private hospitals having a greater number of surgical beds and operating theatres per population than public hospitals. These data indicated how surgical providers and basic infrastructure were distributed in South Africa, which will allow more accurate planning by government policymakers. Recommendations need to be tailored according to each sector as the needs of the patients and resources available are different. There is a need to acknowledge the major shortage of healthcare providers with implementation of the National Health Insurance (NHI). There is a need for validated instruments to accurately collect data and for reliable electronic information sharing which will improve data collection and analysis between rural and urban areas. Existing resources need to be utilized more effectively. These results showed that regional hospitals lack both specialist and non-specialist general surgeons. The international consensus was that performing surgery at district level hospitals improved access and lowered cost, however this will need recruitment of additional skilled personnel and infrastructure in order to support surgery at this level. This national audit has provided much needed data on the some of the available surgical resources may influence critical decision-making about funding distribution, resource and training post allocations, as well as address inequalities in service delivery.