A national roadmap for improving children surgical care: an experience from Tanzania

Nearly 1.75 billion children lack access to basic surgical care. The majority are in low- and middle-income countries (LMICs) where 50% of the population are children. Our aim was to develop a policy-level, action-orientated, and implementable strategy to improve children surgery in Tanzania.

A bottom-up participatory approach was used for needs assessment and priority setting. This started 2 years after the launch of Tanzania National Surgical, Obstetrics, and Anesthesia Plans (NSOAPs). Steps taken were: (i) stakeholder identification and engagement, (ii) desk review of existing research, (iii) focused research on access to children surgery, (iv) site visits and geographical mapping of the reach of selected hospitals, and (v) presentation to the ministry of health for validation. Findings were summarized in line with the NSOAP's building blocks.

A bottom-up approach was feasible in identifying children surgical care challenges of policy priority. We noted that regional hospitals are the main provider of children surgery but majority lacked the necessary resources and were beyond recommended 2-hour reach. A super hub-hub-spoke model is a feasible model to pragmatically address patient, provider, facility and national challenges at all levels of healthcare system.

Our findings propose a roadmap to practically achieve access to children surgery, complementing existing NSOAPs. It highlights feasibility of the approach in developing context relevant interventions that could guide integration of surgery in existing national plans. Developing a functional surgical system in LMICs should be pragmatic to improve overall quality of children surgical care despite limited resources.