Service delivery

Recommendations

Actions

Responsible body

Surgical volume; system coordination; quality and safety safety

• All first-level hospitals should provide laparotomy, caesarean delivery, and open-fracture treatment (Bellwether Procedures)

• Promote functionning referral system for district hospitals to refer up and communication networks with higher level specialists

• Establish a common definition of 1^st level hospitals and agree on the list of surgical procedures to be carried out at this level.

• Establish checklist/criteria/minimum requirements for delivering agreed set of surgical procedures at 1^st level hospitals.

• Assess capacity of 1^st level hospitals (public and private) to carry out agreed surgical procedures according to the above checklist.

• Build the capacity of 1^stlevel hospitals according to the identified gaps.

• Establish a common M&E framework for assessing the performance

• Establish measures and indicators for quality improvement

• PAAS committee and national focal points (from Ministry of health and social welfare)/National central Statistics department /Regional Surgical colleges/Regional quality assurance bodies

• WHO and Health Matrix Networks for technical support

• Integrate public and private NGO providers into common national delivery framework; promote demand-driven partnerships with NGOs to build surgical capacity

• Develop/revise legal and regulatory frameworks to facilitate integration of public and private health practices.

• Identify potential and active partners in healthcare and Create alliances/agreements with multilateral and bilateral global, regional and local public and private health care instructions which can supply affordable, sustainable and minimum condition of services (supplies, technology, equipments, and skills/trainings etc, share best practices).

• Establish national Health Insurance system and negotiate with private health service providers to participate at reduced cost

• PAAS committee

• Focal points , bilateral/multilateral agencies and NGOs for active negotiations

• Prioritise health-care management training

• Develop and implement a costed HRH training plan.

• Develop and implement health care specific (including surgical care ) curriculum and training modules

• Establish HCW exchange programs to foster/share knowledge and best practices.

• Conduct periodic assessment of impact of trainings on quality of care through supportive supervision and operational research

• PAAS committee

• AU department of HRST and PAU

• NEPAD

• Prioritise quality improvement processes and outcomes monitoring

• Promote appropriate surgical workforce and regional specialists

• Agree and establish quality improvement indicator list and build capacity of health care system to achieve them.

• Develop and institutionalize tools for quality assessment.

• PAAS/National Focal points

• WHO

• AU DSA

• Promote telemedicine to build system-wide connectivity

• Promote system-wide connectivity for telemedicine applications, clinical support and education

• Identify and use ICT tools for on –the job training of HHR.

• PAAS committee

• AU economic affairs/ African telemedicine program./AU DHRST

• Virtual universities/PAU

Workforce

Recommendations

Actions

Responsible body

Surgical, anaesthetic, and obstetric providers; allied health providers (nursing, operational manager, biomedical engineers, and radiology, pathology, and laboratory technician officers)

• Establish training and education strategy based on population and needs of country

• Require rural component of surgical and anaesthetic training programmes

• Require training program in remote hospitals where training can take place

• Training an education strategy of surgeons,O&G,anesthetics and ancillary staff based on Essential and Emergency surgeries as defined by WHO

• Accreditation of regional surgical training centres

• Accreditation of Regional Surgical Skills centres

• Conduct surgical human resource need assessment for rural and urban segments and use the information to advocate for training and education strategy development .

• Establish or Build capacity of existing local and regional health/medical training institutes to train HCW at affordable and sustainable cost.

• Set standards on the numbers and mix of staff, distribution and competencies.

• Promote on the job –practical trainings for midlevel health work force to adapt /adopt task-shifting approach.

• Conduct regular, integrated and coordinated supportive supervision of surgical workforce to develop and maintain their skills.

• PAAS committee/National Ministry of higher education/Ministry of Health and Social Welfare

• AU PAU/DSA and HRST

• WHO for technical support

• Develop a context-appropriate licensing and credentialing requirement for all surgical workforce

• Develop a context-appropriate licensing and credentialing requirement for all surgical workforce

• Establish criteria for and mechanisms to assess and ensure surgical workforce licence retention

• PAAS committee/PAU and National Focal Point

• Invest in professional health-care manager training and in a mandatory continuing professional development via workshops,Seminars,Skills courses and Simulation

• Collaborate and create partnership with management training institutions (including public administration, healthcare administration, business) and with Surgical Colleges or other professional training institutions to facilitate provide .

• Work with IT sector to develop online learning portal for health-care managers

• Implement a performance based promotion for professional and all HCW at various levels

• PAAS/PAU/ National Ministry of higher education/MOHSW

• AU-DSA and DHRST

• WHO for technical support

• Establish biomedical equipment training programme

• Define and purchase biomedical equipment for delivering quality health care

• Train and supervise biomedical staff to ensure patients safety and equipment longevity

• Establish equipment inventory system and preventive maintenance plan.

• PAAS/MOHSW and WHO

 Infrastructure

Recommendations

Actions

Responsible body

Surgical facilities; facility readiness; blood supply; access and referral systems

• Track number and distribution of surgical facilities

• Agree on the definition/criteria of a “surgical facility”

• Conduct a nationwide survey to determine the number, location and capacity of “surgical facilities” in each country

• PAAS/National Focal Points

• Regional Surgical Colleges

• AU-PAU and DSA

Resuscitation services for trauma,obstetric care and emergency surgical cases

• Districts to establish the surgical and anaesthetic equipment and supplies need and create a corresponding budget line

• Integrate the surgical equipment/supplies need to the existing district health supply chain system.

• PAAS/MOHSW/National Focal Points/Ministry of Finance

• Equip first-level surgical facilities to be able to do laparotomy, caesarean delivery, and treatment of open fracture (the Bellwether Procedure) and to have access to rehabilitation services

• Primary Health Facilities should work with surgeons and anaesthetists referral hospitals to establish the requirements (staff, equipment, drugs, infrastructure etc) for conducting agreed surgical procedures.

• Develop plan and Establish budget for meeting the surgical and anaesthetic requirement s of priority surgical procedures ( trauma, obstetric procedures ,emergency surgical cases and laparotomy) and for access to rehabilitation services

• Use the existing supply chain system to purchase the required commodities.

• PAAS/MOHSW/MoF

• ADB

• Develop national blood plan

• Collaborate with other programs (eg infectious disease prevention and control program, biomedical laboratories, pharmaceutical companies, local and international NGOs eg Red cross/Red crescent, local communities) to improve or develop safe blood program.

• Work with media and use various platforms (eg sports, commemoration and celebration events, educational) to promote blood donation.

• PAAS/MOHSW/ ministry of information and sports for leading role

• African CDC/AUDSA

• Red cross/crescent

• MSF

• Reduce barriers to access through ambulances,good roads,electricity and water supplies and enhanced connectivity across entire care delivery chain from community to tertiary care

• Establish referral systems with community integration, transfer criteria, referral logistics, and protection for first responders and helpful members of the public

• Involve community influential leaders ( religious, traditional, business, political figures) to promote healthcare seeking behaviours.

• Promote community healthcare workers to educate and refer patients to HC facilities.

• Use the advantage of IT eg mobile phones (toll free emergency help line) to provide health information and education and promote service utilization and referral.

• Establish a reliable transport system and command chain for emergency cases

• As much as possible countries should establish a national health insurance to minimize out of pocket payment

• Where cost sharing is applicable, countries should establish waver system to ensure equitable access to care.

• PAAS/National focal point

• AU-Infrastructure and energy

• ADB-financing

• WHO-technical support

Financing

Health financing and accounting, budget allocation

• Cover basic surgical packages with universal health coverage

• Review/develop essential health care package to cover basic surgical services.

• PAAS/ MoF/MOHSW-leading role

• ADB –Financing

 Information Management

Recommendations

Actions

Responsible body

Information systems; research agenda

• Develop urgently a robust information systems to monitor clinical processes, cost, outcomes, and identify deficits at an African Continental Level

• Develop database / integrated Medical Record System

• Build capacity of HCW to collect, analyse, disseminate and utilise health system data for planning and improvement of service delivery..

• PAAS/National Focal Points

• AU DHRST/PAU/Regional surgical colleges

• WHO/Health Matrix Networks

• Identify, regulate, and fund surgical research priorities of local relevance

• Work with academia to develop /improve capacities of HCW to conduct health and related research

• Establish /improve health research in collaboration with existing research networks

• Identify and collaborate with local and international health program such as Bill& Melinda, CHAI etc) for research funding.

• PAAS/MoHSW

• PAU

• AUDHRST

• Africa CDC