Surgical Assessment Tool for Ethiopia National Policy Monitoring & Evaluation

Development of a Surgical Assessment Tool for National Policy Monitoring & Evaluation in Ethiopia: A Quality Improvement Study

Introduction: A baseline assessment of surgical capacity is recommended as a first-step to inform national policy on surgical system strengthening. In Ethiopia, the World Health Organization's Situational Analysis Tool (WHO SAT) was adapted to assess surgical capacity as part of a national initiative: Saving Lives Through Safe Surgery (SaLTS). This study describes the process of adapting this tool and initial results.

Methods: The new tool was used to evaluate fourteen hospitals in the Southern Nations, Nationalities, and People's Region of Ethiopia between February and March 2017. Two analytic methods were employed. To compare this data to international metrics, the WHO Service Availability and Readiness Assessment (SARA) framework was used. To assess congruence with national policy, data was evaluated against Ethiopian SaLTS targets.

Study Overview

• Status: Completed
• Conditions: Public Health; Global Surgery; Health System; Health Planning; Global Anesthesia

• Study Type: Observational
• Enrollment (Actual): 14

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

The Southern Nations, Nationalities and Peoples' (SNNP) Region is one of Ethiopia's eleven regions, occupying the southwest portion of the country. Public hospitals serve the region's population in this area within three tiers - primary, general, and specialized hospitals. An average of four providers were interviewed per facility and participants included hospital leadership (CEOs, medical directors, and matrons), surgeons, integrated emergency surgical officers, obstetrician-gynecologists, mid-level anesthesia providers, and operating room nurses.

Description

Inclusion Criteria:

• Fourteen public hospitals (11 primary, 1 general, and 2 specialized) chosen by the regional health bureau
• Hospital staff with willingness to participate in study
• Hospital staff with availability to participate in study

Exclusion Criteria:

• Hospital staff which did not volunteer to participate or refused to participate were excluded.
• Hospital staff not available at the time of visit
• Hospitals not chosen by the regional health bureau

Study Plan

How is the study designed?

Design Details

• Observational Models: Ecologic or Community
• Time Perspectives: Cross-Sectional

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
General service readiness	Measured by the number of hospital beds, major operating rooms, surgical/anesthesia/and obstetric providers, and basic infrastructure availability	Cross-Sectional, assesses availability of this infrastructure within the past year in general
Basic surgery readiness	Readiness for surgical services was assessed based on the presence of tracer items identified by WHO/USAID Service Availability and Readiness Assessment (SARA) as particularly important for providing basic surgical services. The service specific readiness score is defined as the mean availability of service specific tracer items in three domains (staff and training, equipment, and medicines and commodities).	Cross-Sectional, assesses availability of tracer items within the past year in general
Comprehensive surgery readiness	Readiness for surgical services was assessed based on the presence of additional tracer items identified by WHO/USAID Service Availability and Readiness Assessment (SARA) as necessary to provide comprehensive surgical services, beyond those needed for basic surgery.	Cross-Sectional, assesses availability of tracer items within the past year in general

Collaborators and Investigators

• Sponsor: Harvard Medical School (HMS and HSDM)
• Collaborators: General Electric; Jhpiego; Federal Minstry of Health of Ethiopia
• Investigators: Principal Investigator: John G Meara, MD, DMD, MBA, Harvard Medical School & Boston Children's Hospital

Study record dates

Study Major Dates

• Study Start (Actual): November 1, 2016
• Primary Completion (Actual): February 23, 2019
• Study Completion (Actual): February 23, 2019

Study Registration Dates

• First Submitted: January 21, 2020
• First Submitted That Met QC Criteria: February 17, 2020
• First Posted (Actual): February 19, 2020

Study Record Updates

• Last Update Posted (Actual): February 19, 2020
• Last Update Submitted That Met QC Criteria: February 17, 2020
• Last Verified: February 1, 2020

More Information

Terms related to this study

• Other Study ID Numbers: IJS-D-19-00363R1

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: Yes
• IPD Plan Description: Raw data from the survey is available in the study and appendices planned for publication. Additionally, the original source data without identification of the specific hospitals, is available upon request with author consensus.
• IPD Sharing Time Frame: Once the original study is published, de-identified results will be available by request to the authors.
• IPD Sharing Access Criteria: Original data may be provided upon request to the authors with consensus approval from all co-authors.
• IPD Sharing Supporting Information Type: Study Protocol; Clinical Study Report (CSR)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No