Organization of Essential Services and the Role of First-Level Hospitals

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.