Barriers to Performing Essential Surgery at First-Level Hospitals in Pakistan: A Mixed Methods Study

Area of Science:

• Public Health
• Surgical Care Access
• Health Systems Research

Background:

• Underutilization of public health sector for surgery in Pakistan leads to patient diversion.
• Diversion to private facilities increases patient out-of-pocket costs and overburdens urban centers.
• Barriers to surgical care in first-level hospitals in Pakistan's Sindh province are investigated.

Purpose of the Study:

• To determine the barriers to surgical care in first-level public hospitals in Pakistan's Sindh province.
• To identify factors hindering access to essential surgical services at the primary care level.

Main Methods:

• A concurrent nested mixed methods study was conducted in May-June 2021.
• Fifteen first-level public hospitals across six districts in Sindh province were surveyed.
• Quantitative data collected using a WHO-adapted tool; qualitative data from staff interviews.

Main Results:

• Lack of trained surgical staff (surgeons, anesthesiologists, obstetricians/gynecologists) is the most significant barrier.
• Limited availability of essential equipment like functioning X-ray and ultrasound machines, and consistent blood transfusion services.
• Qualitative findings confirm human resources as the primary obstacle to surgical care provision.

Conclusions:

• The critical shortage of human resources for surgery presents a substantial challenge.
• Task-shifting to medical officers and trainee anesthesiologists occurs without formal regulation or monitoring.
• Developing surgical workforce capacity is essential for improving the quality of surgical care.