1. Status of surgical activity in Sierra Leone in 2012 Results from a country wide survey Håkon A. Bolkan Chairman – CapaCare 19. June 2014

2. The project

3. Baseline study - Aim 1.Establish a baseline for surgical and obstetrical activity in Sierra Leone in 2012 2.Comprehensive mapping of nationwide major surgical activity 3.Identify training resources (Hosp/organisations) Bolkan, et al - Submitted 2014

4. Facilities performing one or more of the comprehensive surgical procedures listed in the WHO used Service and Readiness Assessment (SARA) tool. Methodology - selection of institutions (1)

5. Selection of institutions (2)

6. Methodology - process Data collection January – May 2013 Medical students Source of data – Operation Theatre Logbooks – Delivery log books – Anesthesia log books Duplicates removed

7. Results

8. Major surgeries in SL in 2012: 24 152

9. Results: Nationwide Surgical volume by district and sector N = 24 152

10. Major surgeries/100 000 population National average X 30

11. Surgical activity by sector 54,0% 39,6%6,4%

12. Results

15. Surgical HR 1.Full Time Equivalent (FTE) 2.Only staff performing surgery counted

16. Surgical HR - Who ConsultantMedical DoctorNurseAssociate ClinicianTotal n%n%n%n%n% 58,535,4 %87,052,6 %6,23,7 %13,88,3 %165,4

17. HR – FTE per provider and sector ConsultantMedical DoctorNurseAssociate ClinicianTotal n%n%n%n%n% Governmental21,336,3 %50,157,6 %2,032,4 %3,021,8 % 76,346,2 % Private For Profit12,821,9 %4,35,0 %0,11,4 %3,021,8 % 20,212,2 % Private Non Profit24,441,7 %32,637,5 %4,166,2 %7,856,4 % 68,841,6 % Total58,535,4 %87,052,6 %6,23,7 %13,88,3 %165,4

18. HR – Surgical activity by healthcare provider and sector

19. HR – Surgical activity by healthcare provider nationality and sector

20. Major surgical procedures by 100 000 population

21. Conclusion 1.Large unmet need for major surgery in Sierra Leone 1.Large discrepancies between urban and rural areas 2.Physician constrains in District hospitals 1.Private Non Profit is a major surgical service provider 2.Surgery and obstetrics – developed as one service

22. Aim: Increase surgical capacity and activity in Sierra Leone 2011201320142015 20162012 2017 Training program Baseline study - Nationwide Service provision Goal: 30 Goal: 100% increase Monitoring Quality DH Training Housemanship

23. www.capacare.org