Cost of surgery in a low-income setting in eastern Uganda.
BACKGROUND
Operative interventions have traditionally been seen as expensive; therefore, surgery has been given low priority in global health care planning in low-income countries. A growing body of evidence indicates that surgery can also be highly cost effective in low-income settings, but our current knowledge of the actual cost of surgery in such settings is limited. This study was carried out to obtain data on the costs of commonly performed operative procedures in a rural/semiurban setting in eastern Uganda.


METHODS
A prospective, facility-based study carried out at a general district hospital (public) and a mission hospital (private, not-for-profit) in the Iganga and Mayuge districts in eastern Uganda. Items included in the cost calculations were staff time, materials and medicines, overhead costs, and capital costs.


RESULTS
The cost of surgery was higher at the mission hospital, with higher expenditure and lower productivity than the public hospital. The most commonly performed major procedures were caesarean section, uterine evacuation, and herniorrhaphy for groin hernia. The costs for these interventions varied between $68.4 and $74.4, $25.0 and $32.6, and $58.6 and $66.0, respectively. The most commonly performed minor procedures were circumcision, suture of cuts and lacerations, and incision and drainage of abscess. The costs for these interventions varied between $16.2 and $24.6, $15.8 and $24.3, and $10.1 and $18.6, respectively.


CONCLUSIONS
The cost of surgery in the study setting compares favorably with other prioritized health care interventions, such as treatment for tuberculosis, human immunodeficiency virus/AIDS, and childhood immunization. Surgery in low-income settings can be made more cost effective, leading to increased quantity and improved quality of surgical services.
Department of Surgery and Perioperative Sciences, Umeå University Hospital, Umeå, Sweden. Electronic address: jenny.loefgren@gmail.com.
Jenny
J
Löfgren
Iganga General Hospital, Iganga, Uganda.
Jude
J
Mulowooza
Department of Surgery and Perioperative Sciences, Umeå University Hospital, Umeå, Sweden.
Pär
P
Nordin
Department of Clinical Science and Education (KI SÖS), Södersjukhuset, Karolinska Institute, Stockholm, Sweden.
Andreas
A
Wladis
Department of Public Health Sciences, Karolinska Institute, Solna, Sweden.
Birger C
BC
Forsberg
D003362:Cost-Benefit Analysis; D003906:Developing Countries; D005260:Female; D017048:Health Care Costs; D019538:Health Care Surveys; D005102:Health Expenditures; D006767:Hospitals, District / Q000191:economics*; D016304:Hospitals, Private / Q000191:economics*; D006801:Humans; D008297:Male; D011203:Poverty; D011446:Prospective Studies; D018570:Risk Assessment; D012959:Socioeconomic Factors; D013514:Surgical Procedures, Operative / Q000191:economics* / Q000706:statistics & numerical data; D014454:Uganda