After 41 years of cardiac surgery where are

January 30, 2018 | Author: Anonymous | Category: Social Science, Law, Tort Law
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After so many years of OHS in Kenya, what has slowed us down? S.W.O. Ogendo

Cardiac Surgery (World) 4000 cardiac surgery units worldwide

Surgeries per million and units per million

08/04/2015 (Reproduced from Unger F. Worldwide survey on cardiac interventions 1995. Cor Europaeum. 1999;7:128-46; )

Countries able to offer cardiac surgery • Algeria • Botswana • Burkina-Faso • Cameroon • Egypt • Eretria

• Ethiopia • Ghana • Ivory Coast • Kenya • Libya • Mauritania • Mauritius

Countries able to offer cardiac surgery Morocco  Mozambique  Namibia  Nigeria  Rwanda  S. Africa  Senegal 

Sudan  Tanzania  Tunisia  Uganda  Zambia  Zimbabwe 



TOTAL = 26

Countries without ongoing resident programmes. Visiting teams 

Botswana (Mauritian team)



Burkina Faso (French team)



Rwanda

(American, Australian)



Zambia

(Mutima)



Eritrea

(Switzerland, Italian and German)

Countries not hosting visiting teams • South Africa

• Sudan • ?Egypt

Commencement of cardiac surgery S. Africa Egypt Ghana Kenya Nigeria Sudan Ivory Coast Mauritius Zimbabwe Senegal Mozambique Mauritania Ethiopia Eritrea Rwanda Uganda

1958 1963 1964 1973 1974 1977 1978 1984 1988 1995 1998 2002 2003 2004 2006 2007

Cameroon

2009

Burkina-Faso

2010

Namibia

2010

Botswana

2011

Zambia

2011

Algeria

Unknown

Libya

Unknown

Morocco

Unknown

Tunisia

Unknown

Distribution of facilities Egypt S. Africa Nigeria Tunisia Libya Morocco Sudan Kenya Algeria Tanzania Ivory Coast Mauritius Namibia Uganda

48 30** 9 11 7 7 7 7 3** 3 2 2 2 2

Zambia

2

Botswana

1

Burkina-Faso

1

Cameroon

1

Ghana

1

Mauritania

1

Mozambique

1

Rwanda

1

Senegal

1

Zimbabwe

1

Eritrea

1

Ethiopia

1

08/04/2015

Surgical output in Africa Country Algeria Botswana Burkina-Faso Cameroon Egypt Eritrea Ethiopia

Number facilities 15 1 1 1 48 1 1

Cardiac surgeons 35 0 0

100 0 2

Operative numbers/year 3000 2 100 0 16000 60 40

Ghana Ivory Coast Kenya Libya Mauritania Mauritius Morocco Mozambique Namibia

1 2 4 7 1 2 10 1 2

6 7 11 10 0 2 10 1 2

100 250 250 0 30 500 500 50 10

Nigeria Rwanda S. Africa Senegal Sudan Tanzania Tunisia Uganda Zambia Zimbabwe

9 1 30 1 5 3 13 2 2 2

TOTAL

166

15 0 120 5 17 7 80 3 0 1 397 (933 CSTnet)

12 60 12,000 40 2000 105 2500 50 10 0 37,669

Cardiac surgery capacity in Africa. Yankah et. al

History cardiac surgery Kenya • KNH

- 1973

• Karen

hypothermia • KNH

- 1975 CPB machine

• Nairobi Hospital

- 1993

• Mater Hospital

- 1996

08/04/2015

• Aga Khan • Tenwek

• Mombasa (AGK)*

- 2003

Series 1 = KNH, 2 = Nairobi Hospital and 3 = Mater Hospital (2003)

08/04/2015

KHN figures last 10 years 160

140

120

100

80

60

40

20

0

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

Surgeries Per Population (?Needs) 400.000

350.000

300.000

250.000

200.000

150.000

100.000

50.000

0.000

Average for Africa

What are the positive improvements?

Access to service •Overall greater availability of cardiac services •Wider distribution in country •More personnel available

•Skills transfer

infrastructure

Training • Training programme for surgeons ongoing • Return of surgeons from outside the country • Nursing staff

Challenges/obstacles

• Decision to start a programme

Training challenges • Nursing and other support staff for programme • Support units must keep pace training opportunities • Accreditation

Training Challenges (cont) •

Cross institution/border corporation (low)  Training

 Skills

programmes

mix



Public private collaborations



Government prioritisation of training needs

Equipment challenges • Lack of front line equipment. • Maintenance of equipment

• Replacement of equipment • (Inappropriate) Equipment donations

Financing challenges • More private institutions • Public institution more into cost sharing • Down sizing of cardiac allocation in public institution

• Donor inclusion into programme • Agenda maybe different

Treatment options outside Kenya

• Challenge as patients go out (e.g. India and South Africa)

Collective Effect of Challenges on Cardiac Surgery Services

Nigeria: 1974 – 2000. Tex Heart Inst J. 2007; 34(1): 8–1

Kenya: Authors personal database

Management • Personnel • Equipment • Finances • Audit

Audit and research • Audit and value (Operational research studies) • Research collaborations

Addressing Challenges 

Funding



Training



Sustainability plans



Collaborations

Mmed training programmes in Africa  South

Africa. Universities of;

 Cape

Town  Stellenbosch  KwaZulu-Natal  Witwatersrand  Pretoria  Medunsa  Free State

• Ethiopia • Ghana • Kenya

Way Forward • Better manage what we have • Improve services by address challenges • Technology transfer • Vertical • Horizontal

• Government support • Community confidence

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