Operative surgery at the district hospital.

Surgical disease is an important cause of preventable mortality and morbidity, but it is not clear how best to deliver surgical services to under-served rural populations in poorer countries. South Africa's policy is to restructure heath services, with district hospitals and health centres becoming the primary delivery vehicle for quality health care to all South Africans. Among other things this involves defining what services a district hospital should be expected to provide, including the district hospital service package (DHSP). Many felt that the list of district hospital surgical procedures is unrealistic, and it is not clear to what extent the package is deliverable. We therefore studied the operative surgery undertaken at district hospital level in a single region with well-organised primary health care services.