title: A tool and index to assess surgical capacity in low income countries: an initial implementation in Sierra Leone.
abstract: BACKGROUND
  A first step toward improving surgical care in many low and middle income countries is to document the need. To facilitate the collection and analysis of surgical capacity data and measure changes over time, Surgeons OverSeas (SOS) developed a tool and index based on personnel, infrastructure, procedures, equipment, and supplies (PIPES).
  
  
  METHODS
  A follow-up assessment of 10 government hospitals in Sierra Leone was completed 42 months after an initial survey in 2008 using the PIPES tool. An index based on number of operating rooms, personnel, infrastructure, procedures, equipment, and supplies was calculated. An index was also calculated, using the 2008 data for comparison.
  
  
  RESULTS
  Most hospitals demonstrated an increased index that correlated with site visits that verified improved conditions. Connaught Hospital in Sierra Leone had the highest score (9.2), consistent with its being the best equipped and staffed Ministry of Health and Sanitation facility. Makeni District Hospital had the greatest increase, from 3.8 to 7.5, consistent with a newly constructed facility.
  
  
  CONCLUSIONS
  The PIPES tool was easily administered at hospitals in Sierra Leone and an index was found useful. Surgical capacity in Sierra Leone improved between 2008 and 2011, as demonstrated by an increase in the overall PIPES indices.
authors.affiliation: Surgeons OverSeas (SOS), 225 East 6th Street, Suite 7F, New York, NY 10003, USA.
authors.forename: Reinou S
authors.initials: RS
authors.lastname: Groen
authors.forename: Thaim B
authors.initials: TB
authors.lastname: Kamara
authors.forename: Richmond
authors.initials: R
authors.lastname: Dixon-Cole
authors.forename: Steven
authors.initials: S
authors.lastname: Kwon
authors.forename: T Peter
authors.initials: TP
authors.lastname: Kingham
authors.forename: Adam L
authors.initials: AL
authors.lastname: Kushner
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration; D003906:Developing Countries; D004865:Equipment and Supplies, Hospital / Q000600:supply & distribution; D006301:Health Services Needs and Demand; D006801:Humans; D009873:Operating Rooms / Q000592:standards; D011787:Quality of Health Care; D012807:Sierra Leone; D013503:Surgery Department, Hospital / Q000592:standards / Q000706:statistics & numerical data; D013514:Surgical Procedures, Operative / Q000592:standards / Q000706:statistics & numerical data