Increasing access to pediatric surgical care: Assessing district hospital readiness in rural Rwanda

• Published in: World journal of surgery Vol. 48; no. 2; pp. 290 - 315
• Main Authors: Nuss, Sarah R., Nkurunziza, Jonathan, Mugabo, Carol, Kubwimana, Marthe, Benimana, Fanny, Uwera, Cynthia, Nyirasabwa, Theodette, Nyirimanzi, Naphtal, Forbes, Callum, Majyambere, Jean Paul, Kateera, Fredrick, Hedt‐Gauthier, Bethany L., Cubaka, Vincent K.
• Format: Journal Article
• Language: English
• Published: United States 01.02.2024
• Subjects: district hospital; facility capacity assessment; global surgery; organizational readiness; pediatric surgery; global surgery; organizational readiness; readiness assessment; Pediatric surgery; facility capacity assessment; district hospital; capacity building; surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1002/wjs.12032

Introduction/Background Safe and quality surgery is crucial for child health. In Rwanda, district hospitals serve as primary entry points for pediatric patients needing surgical care. This paper reports on the organizational readiness and facility capacity to provide pediatric surgery in three district hospitals in rural Rwanda. Methods We administered the Children's Surgical Assessment Tool, adapted for a Rwandan district hospital, to assess facility readiness across 5 domains (infrastructure, workforce, service delivery, financing, and training) at three Partners in Health supported district hospitals (Kirehe, Rwinkwavu, and Butaro District Hospitals). We used the Safe Surgery Organizational Readiness Tool (SSORT) to measure perceived individual and team readiness to implement surgical quality improvement interventions across 14 domains. Results None of the facilities had a dedicated pediatric surgeon, and the most common barriers to pediatric surgery were lack of surgeon (68%), lack of physician anesthesiologists (19%), and inadequate infrastructure (17%). There were gaps in operating and recovery room infrastructure and information management for pediatric outpatients and referrals. In SSORT interviews (n = 47), the highest barriers to increasing pediatric surgery capacity were facility capacity (mean score = 2.6 out of 5), psychological safety (median score = 3.0 out of 5), and resistance to change (mean score = 1.5 out of 5 with 5 = no resistance). Conclusions This study highlights challenges in providing safe and high‐quality surgical care to pediatric patients in three rural district hospitals in Rwanda. It underscores the need for targeted interventions to address facility and organizational barriers prior to implementing interventions to expand pediatric surgical capacity.