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Implementing surgical services in a rural, resource-limited setting: a study protocol.

Duncan Smith-Rohrberg Maru¹, Ryan Schwarz, Dan Schwarz

¹Nyaya Health, Bayalpata Hospital, Ridikot VDC, Achham, Nepal.

|October 25, 2011

Summary

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This study introduces IMEESC-Plus, a novel approach to expand surgical care in rural Nepal. It assesses the implementation process and quality of services to inform global surgical scale-up in underserved areas.

Area of Science:

Global Health
Implementation Science
Surgical Care Delivery

Background:

Surgical services are inaccessible to many rural poor globally.
Limited data exists on surgical care expansion, especially in rural settings.
The implementation process of rural surgical care has not been studied.

Purpose of the Study:

To conduct the first implementation research study on surgical scale-up in rural Achham, Nepal.
To assess the process and quality of the IMEESC-Plus program.
To inform future large-scale studies on global surgical service expansion.

Main Methods:

Utilizing the World Health Organization's Integrated Management for Emergency and Essential Surgical Care (IMEESC) protocols.
Implementing a threefold strategy: core IMEESC program, community follow-up, and hospital quality improvement (IMEESC-Plus).

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Employing mixed-methods research (qualitative and quantitative) over 18 months (initial and consolidation phases).

Main Results:

Data collection on clinical outcomes and service reception/utilization.
Analysis of the logistical aspects of IMEESC-Plus implementation.
Assessment of the quality of IMEESC-Plus services during the study period.

Conclusions:

The study will describe the logistics and assess the quality of IMEESC-Plus services.
Findings will guide the planning of larger, multi-site studies for global surgical scale-up.
This research addresses a critical gap in understanding rural surgical implementation.