Background
Operative interventions have traditionally been seen as expensive; therefore, surgery
has been given low priority in global health care planning in low-income countries.
A growing body of evidence indicates that surgery can also be highly cost effective
in low-income settings, but our current knowledge of the actual cost of surgery in
such settings is limited. This study was carried out to obtain data on the costs of
commonly performed operative procedures in a rural/semiurban setting in eastern Uganda.
Methods
A prospective, facility-based study carried out at a general district hospital (public)
and a mission hospital (private, not-for-profit) in the Iganga and Mayuge districts
in eastern Uganda. Items included in the cost calculations were staff time, materials
and medicines, overhead costs, and capital costs.
Results
The cost of surgery was higher at the mission hospital, with higher expenditure and
lower productivity than the public hospital. The most commonly performed major procedures
were caesarean section, uterine evacuation, and herniorrhaphy for groin hernia. The
costs for these interventions varied between $68.4 and $74.4, $25.0 and $32.6, and
$58.6 and $66.0, respectively. The most commonly performed minor procedures were circumcision,
suture of cuts and lacerations, and incision and drainage of abscess. The costs for
these interventions varied between $16.2 and $24.6, $15.8 and $24.3, and $10.1 and
$18.6, respectively.
Conclusion
The cost of surgery in the study setting compares favorably with other prioritized
health care interventions, such as treatment for tuberculosis, human immunodeficiency
virus/AIDS, and childhood immunization. Surgery in low-income settings can be made
more cost effective, leading to increased quantity and improved quality of surgical
services.
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Article info
Publication history
Published online: April 28, 2015
Accepted:
January 22,
2015
Footnotes
Funding was received from the Swedish Society of Medicine as well as the Golje Foundation, SLS-171201, Sweden. No funding or other support was received from the industry.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
