Submission ID 131195
| Issue/Objective | Surgical diseases account for roughly one-third of the global burden of disease, yet timely access to safe surgical care remains limited in many low- and middle-income countries. Although Rwanda has made progress through NSOAP implementation, evidence on predictors of surgical volume and referral patterns at district-hospital level remains limited. This study aimed to examine surgical output, identify predictors of surgical volume, describe referral patterns and their causes, and generate practical evidence to support district-level surgical system strengthening. |
|---|---|
| Methodology/Approach | We conducted a nationwide cross-sectional study across all 43 district hospitals in Rwanda using the WHO SAT-EESC framework. Surgical volume, referral frequency, and procedure availability were extracted from DHIS2 and operating theatre registers for the study period. Descriptive, bivariate, multivariable, and spatial analyses were used to assess geographic disparities, predictors of output, and operational referral patterns. A purposive sub-analysis also explored task-sharing practices in selected rural and urban hospitals. |
| Results | A total of 151,032 surgical procedures were reported, with cesarean sections accounting for more than two-thirds of all surgeries. Median surgical volume per hospital was 2,909 procedures, equivalent to 923.97 per 100,000 population, well below the Lancet Commission on Global Surgery benchmark of 5,000. A total of 7,905 referrals were recorded, driven mainly by lack of surgical skills (65.7%), lack of supplies (22.4%), and other causes including equipment issues. In adjusted analysis, surgical admissions, hysterectomy volume, and anesthesiologist availability were significant predictors of surgical output, while surgeon presence was not statistically significant. Geographic disparities were also observed across provinces. |
| Discussion/Conclusion | District surgical productivity in Rwanda is shaped less by surgeon presence alone than by broader system functionality, especially anesthesia capacity, case throughput, and procedural readiness. High referral burdens due to modifiable skill and supply gaps indicate important implementation opportunities under NSOAP II. The findings support targeted interventions in workforce training, supply-chain reliability, and formalized task-sharing. This abstract aligns most strongly with Sub-theme 3: From evidence to impact, with secondary relevance to Sub-theme 2: Equity in action because it focuses on district-level disparities and practical health-system strengthening |
| Presenters and Affiliations | Alexander Habtemariam University of Global Health Equity Marie Merci Cyuzuzo University of Global Health Equity Sarah Derichs University of Global Health Equity Alice Umutoni University of Global Health Equity Anteneh Gadisa University of Global Health Equity Mulugeta Tenna University of Global Health Equity Victor Mithi University of Global Health Equity Emmanuel Nkusi Rwanda Military Hospital Barnabas Alayande University of Global Health Equity Abebe Bekele University of Global Health Equity Pierrette Ngutete Mukundwa University of Global Health Equity Sabin Nsazimana Ministry of Health Rwanda Georges Bucyibaruta University of Global Health Equity Nobhojit Roy University of Global Health Equity |
