“Pediatric Surgery and Anesthesia Capacity in Rwanda : a Survey of District and Referral Hospitals”

Abstract

Background: The Lancet Commission on Global Surgery (LCoGS) released a report in 2015 that highlighted significant inequalities in the availability of safe surgery and anesthetic care around the world. Rwanda could serve as a model for other countries that are developing their own national surgical strategic plans but like much of Africa, the country has a severe shortage of surgical and anesthetic capacity, with numbers more than ten-fold lower than in the United States and Europe.

Aim: The aim of the study was to access pediatric surgical and anesthesia capacity in district and tertiary hospitals in Rwanda.

Methodology: Descriptive, cross-sectional survey was distributed to all district and tertiary hospitals in Rwanda to assess pediatric surgical and anesthesia capacity. The assessment focused on workforce, infrastructure, procedures, Equipment and supplies, Service delivery, Information management, blood product and international cooperation. The WFSA AFAT and PediPIPES tools were used for data collection.

Results: Results show scarcity in pediatric surgical and anesthesia workforce. No pediatric surgeon or anesthesiologist was available at the level of district hospitals. Surgeries on children were done by medical doctors and anesthesia conducted by non-physician anesthetists at the majority of surveyed district hospitals. The majority of hospitals lacked post-operative ICU/NICU services. Bellwether procedures were done at most hospitals with more complex and specialized procedures done at tertiary level of care. Oxygen, water, electricity and blood products were almost available in all surveyed hospitals. Scarcity of specific pediatric size equipment was noted. Tracking of perioperative complications was poor in most cases. Most hospitals reported receiving supply donations from international partners.

Conclusion: Several gaps were noted in each of the domain of focus. The results from this study could serve as a baseline to improve perioperative care of children in Rwanda as well as a guide to advocate for more resource and interventions aimed at strengthening pediatric perioperative care.