Abstract

Background: Most communities in low- and middle-income countries (LMICs) live in rural areas and are served mainly by primary and district hospitals. Many of these hospitals are unable to deliver essential surgical. This study seeks to geographically map these hospitals, and measure their surgical care capacity in Botswana.

Methods: This is a 3 months cross sectional, observational study conducted at the department of surgery, university of Botswana. Google maps was used to geographically map hospitals. A telephonic PIPES tool questionnaire was completed to assess surgical care capacity of hospitals. A telephonic consent was obtained.

Findings: Nine district, and ten primary hospitals were assessed. Their geographic distribution is skewed towards the north- and south-eastern band of the country. The north- and south-western band, and the central parts of the country are served largely by 4 primary hospitals. Intensive care services were largely unavailable except at 3 hospitals. Most hospitals had blood storage resources but no full blood bank services. Endoscopic services were unavailable at most of the hospitals. Basic radiological services (X-ray and Ultrasound) and basic supplies were available at most hospitals. At the time of this study only three hospitals had surgeons and only two had an anaesthetist. Hospitals with a full complement of surgical care specialists had relatively higher PIPES indices. Sparsely populated wide geographic locations had fewer health facilities potentially making health care timely access problematic.

Lack of specialised surgical care providers is a major concern. We recommend investing in training general surgeons and anaesthetist locally and integrating rural district and primary hospital rotations into the training programs. We also recommend targeting a bare minimum of one surgeon and an anaesthetist at each facility. This would increase surgical care capacity, especially at hospitals serving sparely populated areas.

Funding Information: This study received no funding.

Declaration of Interests: The authors have no conflict of interest.

Keywords: Surgical care capacity, Surgical capacity, District hospital surgical capacity, District hospital surgical care capacity

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