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Information Journal Paper

Title

Decentralization and Regionalization of Surgical Care: A Review of Evidence for the Optimal Distribution of Surgical Services in Low-and Middle-Income Countries

Pages

  521-537

Keywords

Low-and Middle-Income Countries (LMICs) 

Abstract

 Background: While recommendations for the optimal distribution of surgical services in high-income countries (HICs) exist, it is unclear how these translate to resource-limited settings. Given the significant shortage and maldistribution of surgical workforce and infrastructure in many low-and middle-income countries (LMICs), the optimal role of Centralization/fa?page=1&sort=1&ftyp=all&fgrp=all&fyrs=all" target="_blank">DeCentralization versus Regionalization (Centralization) of surgical care is unknown. The aim of this study is to review evidence around interventions aimed at redistributing surgical services in LMICs, to guide recommendations for the ideal organization of surgical services. Methods: A narrative-based literature review was conducted to answer this question. Studies published in English between 1997 and 2017 in PubMed, describing interventions to decentralize or regionalize a surgical procedure in a LMIC, were included. Procedures were selected using the Disease Control Priorities’ (DCP3) Essential Surgery Package list. Intervention themes and outcomes were analyzed using a narrative, thematic synthesis approach. Primary outcomes included mortality, complications, and patient satisfaction. Secondary outcomes included input measures: workforce and infrastructure, and process measures: facility-based care, surgical volume, and referral rates. Results: Thirty-five studies were included. Nine (33%) of the 27 studies describing Centralization/fa?page=1&sort=1&ftyp=all&fgrp=all&fyrs=all" target="_blank">DeCentralization showed an improvement in primary outcomes. The procedures associated with improved outcomes after Centralization/fa?page=1&sort=1&ftyp=all&fgrp=all&fyrs=all" target="_blank">DeCentralization included most obstetric, gynecological, and family planning services as well as some minor general surgery procedures. Out of 8 studies on Regionalization (Centralization), improved outcomes were shown for trauma care in one study and cataract extraction in one study. Conclusion: Interventions aimed at decentralizing obstetric care to the district hospital and health center levels have resulted in mortality benefits in several countries. However, more evidence is needed to link service distribution to patient outcomes in order to provide recommendations for the optimal organization of other surgical procedures in LMICs. Considerations for the optimal distribution of surgical procedures should include the acuity of the condition for which the procedure is indicated, anticipated case volume, and required level of technical skills, resources, and infrastructure. These attributes should be considered within the context of each country.

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    APA: Copy

    Iverson, Katherine R., Svensson, Emma, Sonderman, Kristin, Barthelemy, Ernest J., Citron, Isabelle, Vaughan, Kerry A., Powell, Brittany L., MEARA, JOHN G., & Shrime, Mark G.. (2019). Decentralization and Regionalization of Surgical Care: A Review of Evidence for the Optimal Distribution of Surgical Services in Low-and Middle-Income Countries. INTERNATIONAL JOURNAL OF HEALTH POLICY AND MANAGEMENT, 8(9), 521-537. SID. https://sid.ir/paper/338732/en

    Vancouver: Copy

    Iverson Katherine R., Svensson Emma, Sonderman Kristin, Barthelemy Ernest J., Citron Isabelle, Vaughan Kerry A., Powell Brittany L., MEARA JOHN G., Shrime Mark G.. Decentralization and Regionalization of Surgical Care: A Review of Evidence for the Optimal Distribution of Surgical Services in Low-and Middle-Income Countries. INTERNATIONAL JOURNAL OF HEALTH POLICY AND MANAGEMENT[Internet]. 2019;8(9):521-537. Available from: https://sid.ir/paper/338732/en

    IEEE: Copy

    Katherine R. Iverson, Emma Svensson, Kristin Sonderman, Ernest J. Barthelemy, Isabelle Citron, Kerry A. Vaughan, Brittany L. Powell, JOHN G. MEARA, and Mark G. Shrime, “Decentralization and Regionalization of Surgical Care: A Review of Evidence for the Optimal Distribution of Surgical Services in Low-and Middle-Income Countries,” INTERNATIONAL JOURNAL OF HEALTH POLICY AND MANAGEMENT, vol. 8, no. 9, pp. 521–537, 2019, [Online]. Available: https://sid.ir/paper/338732/en

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