Surgical outreach in rural South Africa: are we managing to impart surgical skills?

BACKGROUND The Department of Health in KwaZulu-Natal (KZN) has run a surgical outreach programme for over a decade.Objective. To quantify the impact of the outreach programme by analysing its effect on the operative capacity of a single rural health district. METHODS During 2012, investigators visited each district hospital in Sisonke Health District (SHD), KZN to quantify surgery undertaken by resident staff between 1998 and 2013. Investigators also reviewed the operative registers of the four district hospitals in SHD for a 6-month period (March - August 2012) to document the surgery performed at each hospital. The number of staff who attended specialist-based teaching was recorded in an attempt to measure the impact of each visit. RESULTS From 1998 to 2013, 35 385 patients were seen at 1 453 clinics, 5 199 operations were performed and 1 357 patients were referred to regional hospitals. A total of 3 027 staff attended teaching ward rounds and teaching sessions. In the four district hospitals, 2 160 operations were performed in the 6-month period. There were 653 non-obstetrical operations and the obstetric cases comprised 1 094 caesarean sections, 55 sterilisations and 370 evacuations of the uterus. CONCLUSION The infrastructure is well established and the outreach programme is well run and reliable. The clinical outputs of the programme are significant. However, the impact of this programme on specific outcomes is less certain. This raises the question of the future strategic choices that need to be made in our attempts to improve access to surgical care.