Jessica Forcillo1, David A Watkins2, Andre Brooks3, Christopher Hugo-Hamman4, Laston Chikoya5, Michael Oketcho6, Vinod H Thourani7, Liesl Zühlke8. 1. Division of Cardiac Surgery, Université de Montréal, Department of Cardiac Surgery-Montreal University Hospital Centre (CHUM), Montreal, Québec, Canada. Electronic address: jessica.forcillo@umontreal.ca. 2. Department of Medicine, University of Cape Town, Cape Town, South Africa. 3. Division of General Internal Medicine, University of Washington, Cape Town, South Africa; Chris Barnard Division of Cardiothoracic Surgery, University of Cape Town, Cape Town, South Africa. 4. Department of Cardiology, Windhoek Central Hospital, Windhoek, Namibia. 5. Department of Surgery, The University Teaching Hospital, Lusaka, Zambia. 6. Department of Cardiothoracic Surgery, Uganda Heart Institute, Kampala, Uganda. 7. Department of Cardiothoracic Surgery, MedStar University of Washington, Washington, DC. 8. Department of Medicine, University of Cape Town, Cape Town, South Africa; Division of Paediatric Cardiology, Department of Paediatrics, Red Cross War Memorial Children's Hospital, Faculty 20 of Health Sciences, Cape Town, South Africa.
Abstract
OBJECTIVES: Few African countries have the resources to provide optimal cardiac surgery care. We explored needs at cardiac surgery centers in Namibia, Zambia, and Uganda. Our objectives were (1) to determine the key variables to be included in a cardiac surgery needs assessment tool and (2) to highlight the current initiatives, challenges and opportunities, and future goals for cardiac surgery in these 3 countries. METHODS: We conducted in-depth interviews with stakeholders in each country as well as surveys of surgical facilities. We synthesized our findings using a health systems conceptual framework. Each program's current capacity was compared with a standardized definition of "adequate" surgical capacity. On the basis of these findings, we developed a formal needs assessment questionnaire for use in resource-constrained countries. RESULTS: Although each of these countries has adequate facilities and surgical expertise, they still lack key support staff and material resources. Training and mentorship programs are being built, and the sites participate in cardiovascular research. Yet a comprehensive, multidisciplinary approach-including palliative care and rehabilitation-is lacking, and patients in remote areas are not being served. These observations allowed us to define the variables in our needs assessment tool. CONCLUSIONS: Our study demonstrates the great potential that exists to expand cardiac surgery in Africa and highlights some of the major resource bottlenecks that may hinder the scale-up of surgical programs. Our needs assessment questionnaire will assist ministries of health in building sustainable cardiac surgery programs using innovative Afro-centric solutions.
OBJECTIVES: Few African countries have the resources to provide optimal cardiac surgery care. We explored needs at cardiac surgery centers in Namibia, Zambia, and Uganda. Our objectives were (1) to determine the key variables to be included in a cardiac surgery needs assessment tool and (2) to highlight the current initiatives, challenges and opportunities, and future goals for cardiac surgery in these 3 countries. METHODS: We conducted in-depth interviews with stakeholders in each country as well as surveys of surgical facilities. We synthesized our findings using a health systems conceptual framework. Each program's current capacity was compared with a standardized definition of "adequate" surgical capacity. On the basis of these findings, we developed a formal needs assessment questionnaire for use in resource-constrained countries. RESULTS: Although each of these countries has adequate facilities and surgical expertise, they still lack key support staff and material resources. Training and mentorship programs are being built, and the sites participate in cardiovascular research. Yet a comprehensive, multidisciplinary approach-including palliative care and rehabilitation-is lacking, and patients in remote areas are not being served. These observations allowed us to define the variables in our needs assessment tool. CONCLUSIONS: Our study demonstrates the great potential that exists to expand cardiac surgery in Africa and highlights some of the major resource bottlenecks that may hinder the scale-up of surgical programs. Our needs assessment questionnaire will assist ministries of health in building sustainable cardiac surgery programs using innovative Afro-centric solutions.