Emergency and Essential Surgical Care Capacity across Primary, Secondary, and Tertiary Institutions in Meghalaya, India: A Cross-sectional Study
Authors: Chien Bonnie Y , Singh Khumukcham I , Hashimoto-Govindasamy Laksmi S , Cherian Meena N , Mehrotra Manish , Francis Paul P , Menabde Natela 
Published: September 2019

ABSTRACT

Aim
This study aims to evaluate surgical care systems across tertiary, secondary, and primary health institutions in the state of Meghalaya, India.

Materials and methods
The government of Meghalaya conducted the first comprehensive assessment of surgical capacity at three levels of care: Tertiary hospitals, community health centers (CHCs), and primary health centers (PHCs).
This cross-sectional survey utilized World Health Organization (WHO) tool for situational analysis to assess emergency and essential surgical care (EESC) to capture health facilities’ capacity to perform life-saving and disabilitypreventing surgical interventions, such as resuscitation, surgical, trauma, obstetric, and anesthetic care. Data were collected across four categories Infrastructure, human resources, surgical procedures, and equipment.

Results
The 55 facilities surveyed comprised 8 tertiary hospitals, 26 CHCs, and 21 PHCs. A total of 107,962 surgical presentations were reported across all facilities per year, with the greatest number presenting to PHC. No specialist doctors worked at PHC level; there were 1 anesthesiologist and 2 obstetricians at the CHC level. All of the PHCs or CHCs referred do not provide key emergency and essential surgical procedures, including resuscitation, cesarean section, general anesthesia, laparotomy, and closed and open treatment of fractures. At the tertiary level, only 50% provide cesarean section and laparotomy procedures.

Conclusion
The results of this WHO state survey demonstrate significant gaps, notably in resuscitation, at all lower level health facilities and the absence of obstetric procedures at some tertiary hospitals, in essential and emergency surgical capacity, including human resources, equipment, and infrastructure, across all levels of health institutions in Meghalaya.

Clinical significance
This study is an effort to identify the strengths and limitations of surgical capacity in the state of Meghalaya. The method of the study are simple and results can be extrapolated to other states of the country or any third world state which can translate into enhancement and redirection of resources for an optimum outcome.

Strengths of the study
• This study is driven by the motivation of the government of Meghalaya to address the issue of surgical care capacity.
• The study identifies concrete areas of need in surgical care capacity in a collaborative effort with the government of Meghalaya.
• Given the wealth of information on different levels of care centers provided by the government, specific recommendations for improvement can be made.

Limitations of the study
• Although detailed, the situation analysis survey tool is not fully comprehensive and cannot be used exclusively for program planning.
• Not all care centers were able to be surveyed; thus, the results may be representative of only those surveyed.

How to cite this article
Chien BY, Singh KI, Hashimoto- Govindasamy LS, Cherian MN, Mehrotra M, Francis PP, Menabde N. Emergency and Essential Surgical Care Capacity across Primary, Secondary, and Tertiary Institutions in Meghalaya, India: A Cross-sectional Study. Int J Res Foundation Hospc Health Adm 2016;4(1):35-44.