Assessing the Perioperative Capacity in the Republic of Zambia in Preparation for the First Revision of the National Surgical Obstetric and Anesthesia Plan (NSOAP): A Rapid Survey Method

Abstract

Background: Recognizing unmet surgical needs in low- and middle-income countries (LMICs) has led to worldwide initiatives to scale-up surgical capacity. The Republic of Zambia is preparing for its first National Surgical Obstetric and Anesthesia Plan (NSOAP) revision and there is limited data on Zambia's surgical healthcare capacity. We aim to highlight Zambia's surgical healthcare capacity to inform the NSOAP revision and the method used for the rapid assessment. Methods: The Emergency and Essential Surgical (Perioperative) Healthcare Health Facility Assessment Tool (ZAMSAT) was fashioned. ZAMSAT survey responses were used to provide a cross-sectional assessment of leveled healthcare facilities nationwide. The survey was distributed to 227 first-, second-, and third-level hospitals under the leadership of Zambia's Operating Theater Nurses Interest Group and the MOH. The WhatsApp messenger application was used for survey distribution and collection. Results: Data from 116 leveled facilities in all 10 provinces were captured for a survey response rate of 51.1%. A mix of public, private, and mission/nonprofit hospitals was included. The uninterrupted supply of electricity, oxygen, and clean water was found in less than 40% of all facilities. The overall ability to perform caesarean deliveries was 89%, but the ability to perform a laparotomy or open fracture management was significantly lower at 71% and 37%, respectively. Both the WHO Surgical Safety Checklist and pulse-oximetry use in the theater are consistently used more than 85% of the time. General doctors and anesthesia providers are responsible for the majority of intraoperative care in Zambia. Two-percent of facilities are using electronic records as their only means of medical record keeping. The most common research being performed is observational. Although 7% of facilities report a dedicated budget line for perioperative care, only 30% report the budget is adequate. Forty-percent of facilities have local committees dedicated to perioperative care and only 43% of facilities were aware of the NSOAP (2017–2021). Conclusion: ZAMSAT successfully quantified nationwide perioperative healthcare capacity data to inform the Republic of Zambia's first NSOAP revision. The assessment highlights important gaps in each NSOAP domain that may be addressed to advance perioperative healthcare in Zambia.