Y. Hung1, S. Chaker2, M. Saad2, J. A. Henry3, K. Lan4, E. Slater2,S. K. Madiraju5, P. Mwai5, E. Waiguru6, P. Jani7, P. Nthumba2,7,8 1Sinai Hospital of Baltimore, General Surgery, Baltimore, MD, USA 2Vanderbilt University Medical Center, Plastic Surgery, Nashville, TN, USA 3Baylor College Of Medicine, Houston, TX, USA 4Virginia Commonwealth University, School Of Pharmacy, Richmond, VA, USA 5University of Toledo Medical Center, Department of Urology, Toledo, OH, USA 6Ministry of Health, Nairobi, Kenya 7College of Surgeons of East, Central, and Southern Africa, Arusha, Tanzania 8AIC Kijabe Hospital, Kijabe, NAKURU COUNTY, Kenya
Introduction: To date, most surgical capacity data in Kenya were based on projection and modeling. This study aims to provide real world data in surgical workforce and availability of surgical equipment using a newly developed localized tool, Kenya Hospital Assessment Tool (K-HAT).
Methods: Data were collected in >95% of all level 4 health facilities in Kenya in 2018 (total n=249). Level 4 facilities are the principal primary referral hospital for rural communities. Therefore, scaling up the surgical capacity in level 4 hospitals is an important step. Surgical, anesthetic and obstetric providers (SAO) are defined as General Surgeons, Anesthesia workforce, and Obstetrics and Gynecology (OBGYN). Surgeon, anesthesiologist, and obstetrician density (SAOD) was calculated using SAO divided by the population of that county and was calculated in the unit of per 100,000 population. Availability of general patient care supplies, intra-operative supplies, anesthesia supplies, and non-pharmaceutical equipment (Category 1 includes essential supplies needed for day-to-day surgery and Category 2 includes supplies that can be replaced with alternatives) was recorded for each hospital. Infrastructure and resources including the number of functional operating rooms, sterilization capacity, main sources of water, electricity sources, amongst others, were also collected.
Results: Population in all 47 counties had 47, 564, 296 people. Our nation-wide assessment found there was a total of 106 general surgeons, 58 OBGYN, 1,115 medical officers, 161 dentists, and 2,438 anaesthesia workforce in level 4 hospitals in Kenya in 2018. Surgical Workforce Density (SWD) in Kenya was 8.2 per 100,000 population and SAOD was 5.5 per 100,000 population (Figure 1). Overall, the availability of intra-operative and anesthesia equipment and supplies were 44.5% and 47%, respectively. A little over half of the facilities had general patient care supplies available (59.8%). Non-pharmaceutical supplies availability for Category 1 and Category 2 were 61.7% and 52.3%, respectively. More than three-fourths of the facilities had running water available in the maternity wards (83.1%). Only 35% of facilities always had an available X-ray on-site. About half of the facilities obtained blood from the national or a regional blood center (52.6%).
Conclusion: The SAOD is significantly lower than the recommended threshold by Lancet and availability of radiology services and blood supply were lower than the reported rate in other Sub-Saharan African countries. This highlights the importance of National Surgical Planning in Kenya. The real-world data will be used as the basis for the development of Kenya’s National Surgical, Obstetric, Anesthetic Plan.
