title: Access to emergency and surgical care in sub-Saharan Africa: the infrastructure gap.
abstract: BACKGROUND
  The effort to increase access to emergency and surgical care in low-income countries has received global attention. While most of the literature on this issue focuses on workforce challenges, it is critical to recognize infrastructure gaps that hinder the ability of health systems to make emergency and surgical care a reality.
  
  
  METHODS
  This study reviews key barriers to the provision of emergency and surgical care in sub-Saharan Africa using aggregate data from the Service Provision Assessments and Demographic and Health Surveys of five countries: Ghana, Kenya, Rwanda, Tanzania and Uganda. For hospitals and health centres, competency was assessed in six areas: basic infrastructure, equipment, medicine storage, infection control, education and quality control. Percentage of compliant facilities in each country was calculated for each of the six areas to facilitate comparison of hospitals and health centres across the five countries.
  
  
  RESULTS
  The percentage of hospitals with dependable running water and electricity ranged from 22% to 46%. In countries analysed, only 19-50% of hospitals had the ability to provide 24-hour emergency care. For storage of medication, only 18% to 41% of facilities had unexpired drugs and current inventories. Availability of supplies to control infection and safely dispose of hazardous waste was generally poor (less than 50%) across all facilities. As few as 14% of hospitals (and as high as 76%) among those surveyed had training and supervision in place.
  
  
  CONCLUSIONS
  No surveyed hospital had enough infrastructure to follow minimum standards and practices that the World Health Organization has deemed essential for the provision of emergency and surgical care. The countries where these hospitals are located may be representative of other low-income countries in sub-Saharan Africa. Thus, the results suggest that increased attention to building up the infrastructure within struggling health systems is necessary for improvements in global access to medical care.
authors: Department of Emergency Medicine, University of California San Francisco, 1001 Potrero Avenue, 1E21, San Francisco General Hospital, San Francisco, CA 94110, USA. renee.hsia@ucsf.edu
authors: Renee Y
authors: RY
authors: Hsia
authors: Naboth A
authors: NA
authors: Mbembati
authors: Sarah
authors: S
authors: Macfarlane
authors: Margaret E
authors: ME
authors: Kruk
mesh_terms: D017954:Africa South of the Sahara; D004632:Emergency Medical Services / Q000458:organization & administration / Q000600:supply & distribution*; D006268:Health Facilities / Q000600:supply & distribution; D006297:Health Services Accessibility / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*