Making cardiac surgery feasible in African countries: Experience from Namibia, Uganda, and Zambia

7 April, 2019

Dear HIFA and HIFA-Zambia colleagues,

Citation, abstract and comment from me below.

CITATION: Making cardiac surgery feasible in African countries: Experience from Namibia, Uganda, and Zambia.

Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2019.

Forcillo J.; Watkins D.A.; Brooks A. et al.

https://www.jtcvs.org/article/S0022-5223(19)30264-8/fulltext

ABSTRACT

Objectives: Few African countries have the resources to provide optimal cardiac surgery care. We explored needs at cardiac surgery centers in Namibia, Zambia, and Uganda. Our objectives were (1) to determine the key variables to be included in a cardiac surgery needs assessment tool and (2) to highlight the current initiatives, challenges and opportunities, and future goals for cardiac surgery in these 3 countries.

Method(s): We conducted in-depth interviews with stakeholders in each country as well as surveys of surgical facilities. We synthesized our findings using a health systems conceptual framework. Each program's current capacity was compared with a standardized definition of "adequate" surgical capacity. On the basis of these findings, we developed a formal needs assessment questionnaire for use in resource-constrained countries.

Result(s): Although each of these countries has adequate facilities and surgical expertise, they still lack key support staff and material resources. Training and mentorship programs are being built, and the sites participate in cardiovascular research. Yet a comprehensive, multidisciplinary approach-including palliative care and rehabilitation is lacking, and patients in remote areas are not being served. These observations allowed us to define the variables in our needs assessment tool.

Conclusion(s): Our study demonstrates the great potential that exists to expand cardiac surgery in Africa and highlights some of the major resource bottlenecks that may hinder the scale-up of surgical programs. Our needs assessment questionnaire will assist ministries of health in building sustainable cardiac surgery programs using innovative Afro-centric solutions.

Comment (NPW): Cardiovascualr disease, in particular hypertension and coronary artery disease, are increasingly common in Sub-Saharan Africa. The WHO African regional Office website estimates that 20 million people in the region have cardiovascular disease. The demand for cardiac surgery (eg coronary artery bypass and valve replacement), is likely to increase as people live longer but with increased risk factors (lack of exercise, poor diet, smoking) predisposing them to symptomatic heart disease. Unfortunately the above paper is restricted-access so many of us areunable to read it, but it would be interesting to know more about the current demand and supply for cardiac surgery, and future trends.

Best wishes, Neil

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org