A resource planning analysis of district hospital surgical services in the Democratic Republic of the Congo.
BACKGROUND
The impact of surgical conditions on global health, particularly on vulnerable populations, is gaining recognition. However, only 3.5% of the 234.2 million cases per year of major surgery are performed in countries where the world's poorest third reside, such as the Democratic Republic of the Congo (DRC).


METHODS
Data on the availability of anesthesia and surgical services were gathered from 12 DRC district hospitals using the World Health Organization's (WHO's) Emergency and Essential Surgical Care Situation Analysis Tool. We complemented these data with an analysis of the costs of surgical services in a Congolese norms-based district hospital as well as in 2 of the 12 hospitals in which we conducted the situational analysis (Demba and Kabare District Hospitals). For the cost analysis, we used WHO's integrated Healthcare Technology Package tool.


RESULTS
Of the 32 surgical interventions surveyed, only 2 of the 12 hospitals provided all essential services. The deficits in procedures varied from no deficits to 17 services that could not be provided, with an average of 7 essential procedures unavailable. Many of the hospitals did not have basic infrastructure such as running water and electricity; 9 of 12 had no or interrupted water and 7 of 12 had no or interrupted electricity. On average, 21% of lifesaving surgical interventions were absent from the facilities, compared with the model normative hospital. According to the normative hospital, all surgical services would cost US$2.17 per inhabitant per year, representing 33.3% of the total patient caseload but only 18.3% of the total district hospital operating budget. At Demba Hospital, the operating budget required for surgical interventions was US$0.08 per inhabitant per year, and at Kabare Hospital, US$0.69 per inhabitant per year.


CONCLUSIONS
A significant portion of the health problems addressed at Congolese district hospitals is surgical in nature, but there is a current inability to meet this surgical need. The deficient services and substandard capacity in the surveyed district hospitals are systemic in nature, representing infrastructure, supply, equipment, and human resource constraints. Yet surgical services are affordable and represent a minor portion of the total operating budget. Greater emphasis should be made to appropriately fund district hospitals to meet the need for lifesaving surgical services.
Thomas Jefferson University, Department of Surgery, Philadelphia, PA, USA.
Melanie
M
Sion
World Health Organization (WHO), Department of Health Systems Governance and Financing, Geneva, Switzerland.
Dheepa
D
Rajan
Ministry of Health, Directorate of Planning, Kinshasa, Democratic Republic of the Congo (DRC).
Hyppolite
H
Kalambay
WHO Country Office, Kinshasa, DRC.
Jean-Pierre
JP
Lokonga
Ministry of Health, Global Fund Country Coordination Mechanism Secretariat, Kinshasa, DRC.
Joseph
J
Bulakali
Ministry of Health, Directorate of Primary Health Care Development, Kinshasa, DRC.
Mathias
M
Mossoko
Prime Minister's Office, Kinshasa, DRC.
Dieudonne
D
Kwete
World Health Organization (WHO), Department of Health Systems Governance and Financing, Geneva, Switzerland.
Gerard
G
Schmets
WHO, Service Delivery and Safety Department, Geneva, Switzerland.
Edward
E
Kelley
WHO AFRO Regional Office, Brazzaville, Republic of Congo.
Tarcisse
T
Elongo
WHO AFRO Regional Office, Brazzaville, Republic of Congo.
Luis
L
Sambo
WHO, Service Delivery and Safety Department, Geneva, Switzerland.
Meena
M
Cherian
D000758:Anesthesia; D000776:Anesthesiology; D003365:Costs and Cost Analysis; D003625:Data Collection; D015023:Democratic Republic of the Congo; D003906:Developing Countries; D004630:Emergencies; D006285:Health Planning; D006295:Health Resources; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006767:Hospitals, District; D006801:Humans; D011203:Poverty; D013503:Surgery Department, Hospital; D014944:World Health Organization