Five billion people lack access to safe surgical care worldwide and the greatest burden of unmet surgical need lies in low- and middle-income countries.
The World Health Organization has identified EESC as key components of universal health coverage and the DH as the first point of access to surgical care.
Family medicine (FM) was recognised as a medical specialty by the Health Professions Council of South Africa in 2007, and nine South African universities currently have FM postgraduate training programmes.
The 10 clinical domains of the family physician at the district hospital.
Family physicians are uniquely poised to champion decentralised surgical services for several reasons. They are taught to spearhead DHs’ clinical governance and to act as ‘change agents in the system, offering significant leadership to help take the health services forward’.
Districts may differ – for example, large DHs in metropolitan areas may offer services similar to a regional hospital with surgical departments and some districts may have easy access to a regional hospital, while other districts are very remote. To effectively plan the surgical services in a health district or region, it is necessary to map the available resources (human and physical), not by facility silos but as an integrated health system. This assessment would lead to a better understanding of what procedures can be performed safely and what inputs in terms of workforce, support, equipment and supplies are needed to provide the intended package of care. This, however, can only be implemented with support from the regional- and tertiary-level hospital surgeons and anaesthetists. Such support could include outreach, training, mobile health referral applications and discussion groups, and improved referral and transfer systems.
In summary, we need to do the following to strengthen DH surgical services:
Update the package of emergency and essential surgical procedures for the DH.
Ensure the appropriate equipment and an adequate supply chain for surgical care.
Employ FPs at DHs to strengthen the ability to deliver surgical care and anaesthesia as well as to provide the needed clinical leadership and governance.
Enlist support from surgeons and anaesthetists at the regional and tertiary hospitals.
Strengthening DH surgical services would improve universal health coverage, an important objective of the upcoming National Health Insurance scheme. FPs who are the cornerstone DH cadre have surgical and anaesthetic technical skills and leadership training and can play a pivotal role.
We would like to acknowledge all the healthcare providers working to improve quality surgical care in South Africa.
The authors have declared that no competing interests exist.
K.C. and P.N. were involved in the conception and design of the study; they drafted the manuscript and approved the final version. S.R., H.H., V.L., J.N., F.C. and R.M. contributed to the conception and interpretation of the data, critically reviewed the manuscript drafts and approved the final version to be published.
The authors confirm that ethical clearance was not needed/required for the study.
The research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Data sharing is not applicable to this article as no new data were created or analysed in this study.
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any affiliated agency of the authors.