title: Challenges of surgery in developing countries: a survey of surgical and anesthesia capacity in Uganda's public hospitals.
abstract: BACKGROUND
  There are large disparities in access to surgical services due to a multitude of factors, including insufficient health human resources, infrastructure, medicines, equipment, financing, logistics, and information reporting. This study aimed to assess these important factors in Uganda's government hospitals as part of a larger study examining surgical and anesthesia capacity in low-income countries in Africa.
  
  
  METHODS
  A standardized survey tool was administered via interviews with Ministry of Health officials and key health practitioners at 14 public government hospitals throughout the country. Descriptive statistics were used to analyze the data.
  
  
  RESULTS
  There were a total of 107 general surgeons, 97 specialty surgeons, 124 obstetricians/gynecologists (OB/GYNs), and 17 anesthesiologists in Uganda, for a rate of one surgeon per 100,000 people. There was 0.2 major operating theater per 100,000 people. Altogether, 53% of all operations were general surgery cases, and 44% were OB/GYN cases. In all, 73% of all operations were performed on an emergency basis. All hospitals reported unreliable supplies of water and electricity. Essential equipment was missing across all hospitals, with no pulse oximeters found at any facilities. A uniform reporting mechanism for outcomes did not exist.
  
  
  CONCLUSIONS
  There is a lack of vital human resources and infrastructure to provide adequate, safe surgery at many of the government hospitals in Uganda. A large number of surgical procedures are undertaken despite these austere conditions. Many areas that need policy development and international collaboration are evident. Surgical services need to become a greater priority in health care provision in Uganda as they could promise a significant reduction in morbidity and mortality.
authors.affiliation: Department of Global Health and Social Medicine, Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA. alli.linden@gmail.com.|Department of Surgery, Georgetown University Hospital, Washington, DC, USA. alli.linden@gmail.com.|, 180 Commonwealth Avenue, Apt. 8, Boston, MA, 02116, USA. alli.linden@gmail.com.
authors.forename: Allison F
authors.initials: AF
authors.lastname: Linden
authors.affiliation: Harvard Humanitarian Initiative, Boston, MA, USA.
authors.forename: Francis Serufusa
authors.initials: FS
authors.lastname: Sekidde
authors.affiliation: Department of Surgery, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
authors.forename: Moses
authors.initials: M
authors.lastname: Galukande
authors.affiliation: Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Lisa Marie
authors.initials: LM
authors.lastname: Knowlton
authors.affiliation: Department of Surgery, The University of Western Ontario, London, ON, Canada.
authors.forename: Smita
authors.initials: S
authors.lastname: Chackungal
authors.affiliation: Harvard Humanitarian Initiative, Boston, MA, USA.|Valley Anesthesiology Consultants, Ltd, Phoenix, AZ, USA.
authors.forename: K A Kelly
authors.initials: KAK
authors.lastname: McQueen
mesh_terms: D000776:Anesthesiology; D003906:Developing Countries; D013502:General Surgery; D006176:Gynecology; D019538:Health Care Surveys; D006295:Health Resources / Q000600:supply & distribution*; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand; D054625:Healthcare Disparities; D006779:Hospitals, Public / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D009774:Obstetrics; D017063:Outcome Assessment, Health Care; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data; D014454:Uganda; D000078329:Workforce