Volume Contents
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▶ Overview Chapter
1: Essential Surgery: Key Messages of this Volume
▶ The Global Burden
2: Global Burden of Surgical Conditions
▶ Surgical Interventions
3: Surgery and Trauma Care
4: General Surgical Emergencies
5: Obstetric Surgery
6: Obstetric Fistula
7: Surgery for Family Planning, Abortion, and Postabortion Care
8: Surgical Interventions for Congenital Anomalies
9: Hernia and Hydrocele
10: Denistry
11: Cataract Surgery
▶ Surgical Platforms and Policies
12: Organization of Essential Services and the Role of First-Level Hospitals
13: Specialized Surgical Platforms
14: Pre-Hospital and Emergency Care
15: Anesthesia and Perioperative Care
16: Excess Surgical Mortality: Strategies for Improving Quality of Care
17: Workforce Innovations to Expand the Capacity for Surgical Services
▶ The Economics of Surgery
18: Costs, Effectiveness, and Cost-Effectiveness of Selected Surgical Procedures and Platforms
19: Task-Sharing or Public Finance for Expanding Surgical Access in Rural Ethiopia: An Extended Cost-Effectiveness Analysis
20: Global Surgery and Poverty
21: Benefit-Cost Analysis for Selected Surgical Interventions in Low- and Middle-Income Countries
Child and Adolescent Health and Development
Organization of Essential Services and the Role of First-Level Hospitals
Authors: Colin McCord,	Margaret Kruk, Charles Mock, Meena Cherian, Johan von Schreeb, Sarah Russell, Mike English
McCord, C., Kruk, M., Mock, C. N., Cherian, M., Schreeb, J. , et. al. 2015. "Organization of Essential Services and the Role of First-Level Hospitals". In: Disease Control Priorities (third edition): Volume 1, Essential Surgery, edited by H. Debas, P. Donkor, A. Gawande, D. T. Jamison, M. Kruk, C. N. Mock. Washington, DC: World Bank.
Properly functioning small hospitals and health centers effectively deliver basic surgical services at very low cost and these surgical services can be one of the most cost-effective components of the public health system in low- and middle-income countries (LMICs). The transport of referred patients presents a major problem for LMIC families with low incomes or 80 percent of the population. First-level hospital care suffers from constraints in (1) lack of trained staff, (2) inadequate supplies and equipment; (3) intermittent or absent water and electricity; and (4) transportation challenges. The most common emergency surgical procedure is obstetrical in nature while major trauma may either not be seen or be referred elsewhere. First-level hospitals in Sub-Saharan Africa, South Asia, and Latin America estimate a cost of US$33 per DALY averted. The use of anesthesia runs up the cost of surgeries, and new technologies present challenges due to costs and need for training.
DCP3_Essential Surgery_Ch12.pdf