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

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.
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