title: Estimation of Surgery Capacity in Haiti: Nationwide Survey of Hospitals.
abstract: BACKGROUND
  Haiti's surgical capacity was significantly strained by the 2010 earthquake. As the government and its partners rebuild the health system, emergency and essential surgical care must be a priority.
  
  
  METHODS
  A validated, facility-based assessment tool developed by WHO was completed by 45 hospitals nationwide. The hospitals were assessed for (1) infrastructure, (2) human resources, (3) surgical interventions and emergency care, and (4) material resources for resuscitation. Fisher's exact test was used to compare hospitals by sectors: public compared to private and mixed (public-private partnerships).
  
  
  RESULTS
  The 45 hospitals included first-referral level to the national referral hospital: 20 were public sector and 25 were private or mixed sector. Blood banks (33% availability) and oxygen concentrators (58%) were notable infrastructural deficits. For human resources, 69% and 33% of hospitals employed at least one full-time surgeon and anaesthesiologist, respectively. Ninety-eight percent of hospitals reported capacity to perform resuscitation. General and obstetrical surgical interventions were relatively more available, for example 93% provided hernia repairs and 98% provided cesarean sections. More specialized interventions were at a deficit: cataract surgery (27%), cleft repairs (31%), clubfoot (42%), and open treatment of fractures (51%).
  
  
  CONCLUSIONS
  Deficiencies in infrastructure and material resources were widespread and should be urgently addressed. Physician providers were mal-distributed relative to non-physician providers. Formal task-sharing to midlevel and general physician providers should be considered. The parity between public and private or mixed sector hospitals in availability of Ob/Gyn surgical interventions is evidence of concerted efforts to reduce maternal mortality. This ought to provide a roadmap for strengthening of surgical care capacity.
authors.affiliation: University of California Haiti Initiative, Los Angeles, CA, USA.
authors.forename: Tu M
authors.initials: TM
authors.lastname: Tran
authors.forename: Mackenson
authors.initials: M
authors.lastname: Saint-Fort
authors.forename: Marie-Djenane
authors.initials: MD
authors.lastname: Jose
authors.forename: Jean Hugues
authors.initials: JH
authors.lastname: Henrys
authors.forename: Jacques B
authors.initials: JB
authors.lastname: Pierre Pierre
authors.forename: Meena N
authors.initials: MN
authors.lastname: Cherian
authors.forename: Richard A
authors.initials: RA
authors.lastname: Gosselin
mesh_terms: D000776:Anesthesiology; D001771:Blood Banks; D004636:Emergency Service, Hospital; D004865:Equipment and Supplies, Hospital / Q000600:supply & distribution; D013502:General Surgery; D006205:Haiti; D019538:Health Care Surveys; D006295:Health Resources / Q000600:supply & distribution*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D016304:Hospitals, Private / Q000706:statistics & numerical data*; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D055818:Public-Private Sector Partnerships; D012151:Resuscitation / Q000295:instrumentation; D066231:Surgeons / Q000600:supply & distribution; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D000078329:Workforce