Using ACS NSQIP data from U.S. hospitals, we validated statistical
models that are tailored to the constraints of a Mozambican setting.
We found that a minimum set of four to six variables is adequate
to achieve robust risk-adjustment for inpatient outcomes.
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Challenges: surgeon shortages
Despite early successes, the UEM-UCSD surgical
partnership has faced several challenges, the greatest being the lack of surgeons in Mozambique.
With fewer than 25 general surgeons serving a
population of 25 million people in Mozambique,
practicing surgeons have little time for day-to-day
research activities. The Ministry of Health’s recent
decision to expand the general surgery postgraduate training program should help to remedy this
problem, but these effects will take years to reach
fruition. In the meantime, the MEPI team has
sponsored the research of three NPTs. These tecni-cos de cirurgia are required to complete a research
project as part of their certification through Maputo’s Higher Institute of Health Sciences. The goal
of this mandate is to empower these health care
professionals to perform surgical research at primary referral hospitals in rural districts.
As the UEM-UCSD surgical partnership continues to develop, we see several areas where future
research should be focused.
One of the greatest challenges of scaling
up surgical care in LMICs lies in the deficien-cies in the supply, training, and distribution of
human resources. Surgical training takes time
and money. Once qualified, surgeons are reluctant to serve in rural primary referral hospitals
where the needs are greatest. Important questions remain regarding how surgical providers
in LMICs should be trained, how their scope of
practice should be defined, and how surgical skills
should be assessed.
Another important need is the development
of frameworks to assess surgical care within primary health care systems. The development of
indicators for monitoring and evaluating projects
and system performance is commonplace within
health and economic development programs, but
this process has yet to be systematically applied
to the practice of surgery in LMICs. Developing
population-based indicators of surgical care will
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