Browsing Doctoral Degrees (Health Systems and Public Health) by browse.metadata.advisor "Clarke, Damian"
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- ItemMulti-level system assessment of the Ghanaian emergency, trauma, and surgical care system : a roadmap for development(Stellenbosch : Stellenbosch University, 2019-04) Stewart, Barclay T.; Volmink, Jimmy; Quansah, Robert; Clarke, Damian; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems & Public Health.ENGLISH SUMMARY : This dissertation is a compilation and evolution of a multi-level assessment of emergency, trauma and surgical care in Ghana that was designed to provide benchmarking data, identify key gaps, and outline a plan for development. The work began with an assessment of surgical and trauma care capacity at district, regional and tertiary hospitals nationwide. The results demonstrated critical deficiencies in essential resources that limit the quality of care that could be provided to the sick and injured. However, when compared to a similar assessment a decade prior, there were notable improvements, which highlighted the potential for positive change, and identified existing opportunities for capacity building. While this work was being completed, three major movements in global surgery and international health policy were afoot that mandated a better understanding of access to essential surgical and trauma care and evaluation and monitoring of essential surgical and trauma care. Therefore, to stay relevant and contribute meaningfully to the meta-discussion in global surgery, we set out to pilot the collection and use of these metrics in Ghana. In addition to the assessments of capacity, piloting of the new metrics was done by: i) enumerating all operations done in the country in one year, ii) describing geospatial access to surgical care, and iii) modeling the risk of catastrophic expenditure for people who need surgery. During this phase of the work, several findings were noted. First, it seemed that surgical capacity was not directly associated to surgical output, which contrasted with the current assumptions regarding surgical capacity assessments and capacity building initiatives. Therefore, we set out to examine this relationship with data from the national capacity assessment and surgical enumeration. This study confirmed our suspicions: there was no association between capacity and output. The findings suggested that several non-measured factors were important for improving output, such as differential barriers to care, process components (e.g., protocols, policies, emotional infrastructure), and system coordination. Therefore, we sought to further characterize these components and develop a system-wide roadmap for emergency, trauma, and surgical care system development. This was done by: developing, piloting and expanding a barriers to care assessment tool; developing context-appropriate audit filters to investigate the trend of process metrics; and developing and piloting the World Health Organization (WHO) Emergency Care System Assessment Tool (ECSAT) in Ghana. The data from the entire work allowed for a rich description of the state of emergency, trauma, and surgical care in the country, identification of the key gaps, and creation of a roadmap for development. The latter was done in conjunction with the Ghana Ministry of Health and was turned over to them for implementation and monitoring by in-country partners. The work in total demonstrated the utility of multi-level assessments in planning for strategic development of the healthcare system, and contributed meaningfully to the global surgery movement with regards to tool creation and piloting of several novel metrics.