title: Development of a surgical capacity index: opportunities for assessment and improvement.
abstract: BACKGROUND
  Significant gaps exist in the provision of surgical care in low- and middle-income countries (LMICs). The purpose of this study was to develop a metric to monitor surgical capacity in LMICs.
  
  
  METHODS
  The World Health Organization developed a survey called the Tool for Situational Analysis to Assess Emergency and Essential Surgical Care. Using this tool, we developed a surgical capacity scoring index and assessed its usefulness with data from Sierra Leone, Liberia, and the Solomon Islands.
  
  
  RESULTS
  There were data from 10 hospitals in Sierra Leone, 16 hospitals in Liberia, and 9 hospitals in the Solomon Islands. The levels of surgical capacity were created using our scoring index based on a possible 100 points: level 1 for hospitals with <50 points, level 2 with 50-70 points, level 3 with 70-80 points, and level 4 with >80 points. In Sierra Leone, 44% of the hospitals had a surgical capacity rating of level 1, 50% level 2, and 10% level 3. In Liberia, 37.5% of the hospitals had a surgical capacity rating of level 1, 56.3% level 2, and only one hospital level 3. For Sierra Leone and Liberia, two factors--infrastructure and personnel--had the greatest deficits. In the Solomon Islands, 44.4% of the hospitals had their surgical capacity rated at level 1, 22.2% at level 2, 11.1% at level 3, and 22.2% at level 4.
  
  
  CONCLUSIONS
  Pending pilot testing for reliability and validity, it appears that a systematic hospital surgical capacity index can identify areas for improvement and provide an objective measure for monitoring changes over time.
authors.affiliation: Department of Surgery, University of Washington, 1959 NE Pacific Street, Box 356410, Seattle, WA 98195-6410, USA. skwon11@uw.edu
authors.forename: Steve
authors.initials: S
authors.lastname: Kwon
authors.forename: T Peter
authors.initials: TP
authors.lastname: Kingham
authors.forename: Thaim B
authors.initials: TB
authors.lastname: Kamara
authors.forename: Lawrence
authors.initials: L
authors.lastname: Sherman
authors.forename: Eileen
authors.initials: E
authors.lastname: Natuzzi
authors.forename: Charles
authors.initials: C
authors.lastname: Mock
authors.forename: Adam
authors.initials: A
authors.lastname: Kushner
mesh_terms: D057191:Capacity Building; D003906:Developing Countries; D006295:Health Resources / Q000592:standards / Q000706:statistics & numerical data*; D006296:Health Services; D006297:Health Services Accessibility / Q000592:standards / Q000706:statistics & numerical data*; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data; D007988:Liberia; D008542:Melanesia; D011785:Quality Assurance, Health Care; D058996:Quality Improvement; D012807:Sierra Leone; D013503:Surgery Department, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D014944:World Health Organization