Identifying knowledge needed to improve surgical care in Southern Africa using a theory of change approach

Danyca Shadé Breedt; Maria Lisa Odland; Balisi Bakanisi; Edward Clune; Moneimang Makgasa; John Tarpley; Margaret Tarpley; Akutu Munyika; Jacob Sheehama; Theresia Shivera; Bruce Biccard; Regan Boden; Sean Chetty; Liesl de Waard; Rowan Duys; Kristin Groeneveld; Susan Levine; Tamlyn Mac Quene; Salome Maswime; Megan Naidoo; Priyanka Naidu; Shrikant Peters; Ché L Reddy; Savannah Verhage; Godfrey Muguti; Shingai Nyaguse; Lucia D'Ambruoso; Kathryn Chu; Justine I Davies; AfroSurg Collaborative

doi:10.1136/bmjgh-2021-005629

Identifying knowledge needed to improve surgical care in Southern Africa using a theory of change approach

BMJ Glob Health. 2021 Jun;6(6):e005629. doi: 10.1136/bmjgh-2021-005629.

Authors

Danyca Shadé Breedt^#¹, Maria Lisa Odland^#², Balisi Bakanisi³, Edward Clune⁴, Moneimang Makgasa⁵, John Tarpley⁶, Margaret Tarpley⁷, Akutu Munyika^{8

9}, Jacob Sheehama¹⁰, Theresia Shivera¹¹, Bruce Biccard¹², Regan Boden¹³, Sean Chetty¹⁴, Liesl de Waard¹⁵, Rowan Duys¹², Kristin Groeneveld¹, Susan Levine¹⁶, Tamlyn Mac Quene¹⁷, Salome Maswime¹⁸, Megan Naidoo¹⁷, Priyanka Naidu¹⁷, Shrikant Peters¹⁹, Ché L Reddy²⁰, Savannah Verhage¹³, Godfrey Muguti²¹, Shingai Nyaguse²², Lucia D'Ambruoso²³, Kathryn Chu^#¹⁷, Justine I Davies^#^{24

17

25}; AfroSurg Collaborative

Affiliations

¹ Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
² Institute of Applied Health Research, University of Birmingham, Birmingham, UK m.l.odland@bham.ac.uk.
³ Faculty of Health Sciences, University of Botswana, Gaborone, Botswana.
⁴ Department of Anaesthesia, University of Botswana, Gaborone, Botswana.
⁵ Department of Surgery, Princess Marina Hospital, Gaborone, Botswana.
⁶ Department of Surgery, University of Botswana, Gabarone, Botswana.
⁷ Department of Medical Education, University of Botswana, Gaborone, Botswana.
⁸ Department of Surgery, University of Namibia, Windhoek, Namibia.
⁹ Department of Surgery, Onandjokwe Lutheran Hospital, Oniipa, Namibia.
¹⁰ University of Namibia, Windhoek, Namibia.
¹¹ Anaesthesiologists Society of Namibia, Windhoek, Namibia.
¹² Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa.
¹³ Faculty of Health Sciences, University of Cape Town, Observatory, South Africa.
¹⁴ Anaesthesiology and Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
¹⁵ Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
¹⁶ Department of Anthropology, Humanities Faculty, University of Cape Town, Cape Town, South Africa.
¹⁷ Centre for Global Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
¹⁸ Global Surgery Division, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
¹⁹ Executive Management, Groote Schuur Hospital, Department of Public Health and Familiy Medicine, University of Cape Town, Cape Town, South Africa.
²⁰ Harvard Medical School, Boston, Massachusetts, USA.
²¹ Department of Surgery, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
²² Division of Anaesthesia, Parirenyatwa Hospital, Harare, Zimbabwe.
²³ Aberdeen Centre for Health Data Science, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland, UK.
²⁴ Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
²⁵ Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.

^# Contributed equally.

Abstract

Surgical healthcare has been prioritised in the Southern African Development Community (SADC), a regional intergovernmental entity promoting equitable and sustainable economic growth and socioeconomic development. However, challenges remain in translating political prioritisation into effective and equitable surgical healthcare. The AfroSurg Collaborative (AfroSurg) includes clinicians, public health professionals and social scientists from six SADC countries; it was created to identify context-specific, critical areas where research is needed to inform evidence-grounded policy and implementation. In January 2020, 38 AfroSurg members participated in a theory of change (ToC) workshop to agree on a vision: 'An African-led, regional network to enable evidence-based, context-specific, safe surgical care, which is accessible, timely, and affordable for all, capturing the spirit of Ubuntu[1]' and to identify necessary policy and service-delivery knowledge needs to achieve this vision. A unified ToC map was created, and a Delphi survey was conducted to rank the top five priority knowledge needs. In total, 45 knowledge needs were identified; the top five priority areas included (1) mapping of available surgical services, resources and providers; (2) quantifying the burden of surgical disease; (3) identifying the appropriate number of trainees; (4) identifying the type of information that should be collected to inform service planning; and (5) identifying effective strategies that encourage geographical retention of practitioners. Of the top five knowledge needs, four were policy-related, suggesting a dearth of much-needed information to develop regional, evidenced-based surgical policies. The findings from this workshop provide a roadmap to drive locally led research and create a collaborative network for implementing research and interventions. This process could inform discussions in other low-resource settings and enable more evidenced-based surgical policy and service delivery across the SADC countries and beyond.

Keywords: health policy; health systems; public Health.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Africa South of the Sahara
Africa, Southern
Health Services Accessibility*
Humans
Public Health*