Slide 1

After so many years of OHS in Kenya, what has slowed us down? S.W.O. Ogendo Slide 2 Cardiac Surgery (World) 22/04/2015 4000 cardiac surgery units worldwide Surgeries per million and units per million (Reproduced from Unger F. Worldwide survey on cardiac interventions 1995. Cor Europaeum. 1999;7:128-46; ) Slide 3 Countries able to offer cardiac surgery Algeria Botswana Burkina-Faso Cameroon Egypt Eretria Ethiopia Ghana Ivory Coast Kenya Libya Mauritania Mauritius Slide 4 Countries able to offer cardiac surgery Morocco Mozambique Namibia Nigeria Rwanda S. Africa Senegal Sudan Tanzania Tunisia Uganda Zambia Zimbabwe TOTAL = 26 Slide 5 Countries without ongoing resident programmes. Visiting teams Botswana (Mauritian team) Burkina Faso (French team) Rwanda (American, Australian) Zambia (Mutima) Eritrea(Switzerland, Italian and German) Slide 6 Countries not hosting visiting teams South Africa Sudan ?Egypt Slide 7 Commencement of cardiac surgery AlgeriaUnknown LibyaUnknown MoroccoUnknown TunisiaUnknown S. Africa1958 Egypt1963 Ghana1964 Kenya1973 Nigeria1974 Sudan1977 Ivory Coast1978 Mauritius1984 Zimbabwe1988 Senegal1995 Mozambique1998 Mauritania2002 Ethiopia2003 Eritrea2004 Rwanda2006 Uganda2007 Tanzania2008 Cameroon2009 Burkina-Faso2010 Namibia2010 Botswana2011 Zambia2011 Slide 8 Distribution of facilities Egypt48 S. Africa30** Nigeria9 Tunisia11 Libya7 Morocco7 Sudan7 Kenya7 Algeria3** Tanzania3 Ivory Coast2 Mauritius2 Namibia2 Uganda2 Zambia2 Botswana1 Burkina-Faso1 Cameroon1 Ghana1 Mauritania1 Mozambique1 Rwanda1 Senegal1 Zimbabwe1 Eritrea1 Ethiopia1 Slide 9 22/04/2015 Slide 10 Surgical output in Africa Country Number facilities Cardiac surgeons Operative numbers/year Algeria15353000 Botswana102 Burkina-Faso10100 Cameroon1 0 Egypt4810016000 Eritrea1060 Ethiopia1240 Slide 11 Ghana16100 Ivory Coast27250 Kenya411250 Libya7100 Mauritania1030 Mauritius22500 Morocco10 500 Mozambique1150 Namibia2210 Slide 12 Nigeria91512 Rwanda1060 S. Africa3012012,000 Senegal1540 Sudan5172000 Tanzania37105 Tunisia13802500 Uganda2350 Zambia2010 Zimbabwe210 TOTAL166 397 (933 CSTnet) 37,669 Slide 13 Cardiac surgery capacity in Africa. Yankah et. al Slide 14 History cardiac surgery Kenya KNH - 1973 hypothermia KNH - 1975 CPB machine Nairobi Hospital - 1993 Mater Hospital - 1996 Karen Aga Khan Tenwek Mombasa (AGK)* - 2003 22/04/2015 Slide 15 Series 1 = KNH, 2 = Nairobi Hospital and 3 = Mater Hospital (2003) 22/04/2015 Slide 16 KHN figures last 10 years Slide 17 Surgeries Per Population (?Needs) Average for Africa Slide 18 What are the positive improvements? Slide 19 Access to service Overall greater availability of cardiac services Wider distribution in country More personnel available Skills transfer Slide 20 infrastructure Slide 21 Training Training programme for surgeons ongoing Return of surgeons from outside the country Nursing staff Slide 22 Challenges/obstacles Slide 23 Decision to start a programme Slide 24 Training challenges Nursing and other support staff for programme Support units must keep pace training opportunities Accreditation Slide 25 Training Challenges (cont) Cross institution/border corporation (low) Training programmes Skills mix Public private collaborations Government prioritisation of training needs Slide 26 Equipment challenges Lack of front line equipment. Maintenance of equipment Replacement of equipment (Inappropriate) Equipment donations Slide 27 Financing challenges More private institutions Public institution more into cost sharing Down sizing of cardiac allocation in public institution Donor inclusion into programme Agenda maybe different Slide 28 Treatment options outside Kenya Challenge as patients go out (e.g. India and South Africa) Slide 29 Collective Effect of Challenges on Cardiac Surgery Services Nigeria: 1974 2000. Tex Heart Inst J. 2007; 34(1): 81 Kenya: Authors personal database Slide 30 Management Personnel Equipment Finances Audit Slide 31 Audit and research Audit and value (Operational research studies) Research collaborations Slide 32 Addressing Challenges Funding Training Sustainability plans Collaborations Slide 33 Mmed training programmes in Africa South Africa. Universities of; Cape Town Stellenbosch KwaZulu-Natal Witwatersrand Pretoria Medunsa Free State Ethiopia Ghana Kenya Slide 34 Way Forward Better manage what we have Improve services by address challenges Technology transfer Vertical Horizontal Government support Community confidence