According to Chu, however, district hospitals are hamstrung by resource and capacity constraints. Many district hospitals, for example, do not have the necessary ICUs and CT scanners and there are things surgical care needs postoperatively that are not there. The surgical care package they can provide is limited, she said.
“The regional hospitals do what we call ‘bread and butter’ surgery and mostly have some good capacity. However, there are many district hospitals that are smaller and in rural areas that should (based on international practice) be providing basic surgical care but what that surgical package of care should look like is not that well defined, specifically in SA.”
Also weighing in on possible solutions to improve the co-ordination of surgical care, associate professor Lydia Cairncross, University of Cape Town Global Surgery Oncology Lead at Groote Schuur Hospital, said from a cost efficiency point of view it is much better to treat patients at a district rather than central hospital level.
“But a lot of relatively minor surgery that could be done at district level hospitals is being done at central or regional hospitals,” said Cairncross.
This adds to the service pressures at these hospitals.
“We need to focus on the district hospitals and ensure they have the capacity to provide a package of surgical procedures. At present it’s very patchy.”
Beefing up the surgical workforce
Both Chu and Cairncross flagged staff shortages, especially theatre nurses, as a huge challenge.
According to Cairncross, the more immediate priority for government is to unfreeze all posts so surgical teams can be capacitated.
“I don’t know how to emphasise this enough,” she said.
“There’s doublespeak happening when we talk about capacity. We need human resources but at the same time we have a growing unemployment crisis among junior doctors. There are people who can do the work but funded posts are not available.”
According to figures from the national health department, by May this year there was a 15.47% vacancy rate of critical skills personnel in the nursing category, which meant 22,655 vacant posts.
“When someone resigns or retires, the post is often left unfilled for six to 12 months and the whole system spirals into chaos while that person isn’t in place. This obviously has knock-on effects with other people who get burnt out and also leave,” said Cairncross.
“The first step in a national co-ordinated response would be to fill all theatre-related vacant posts as a matter of urgency.”