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

Every country has some sort of system to provide surgical and other health services at various levels, with a progressive increase in the capacity to treat more complicated problems. Reliable evidence indicates that properly functioning small hospitals and health centers can deliver effective basic surgical services at very low cost; these surgical services can be one of the most cost-effective components of the public health system in low- and middle income countries (LMICs) (Alkire and others 2012; Debas and others 2006; Gosselin, Thind, and Bellardinelli 2006; Gosselin, Maldonado, and Elder 2010; McCord and Chowdhury 2003). Properly functioning is a key phrase; a hospital lacking personnel trained in surgery and in the administration of anesthesia cannot provide major surgical procedures. Even minor surgery requires trained personnel. More than 50 percent of the disability-adjusted life years (DALYs) averted in a small hospital can derive from surgical treatment, (McCord and Chowdhury 2003) so the cost-effectiveness of these units is drastically reduced if this treatment is not available. 
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