Table 4

Service delivery expected at upgraded health centres, district hospitals and regional hospitals as stipulated in the NSOAP

Upgraded health centresDistrict hospitalsRegional hospitals
Dental:All health centresAll health centres and district procedures plus:
  • Tooth extraction

Procedures plus:OB-GYN
  • Drainage of dental abscess

  • Full emergency service

  • Treatment of caries

  • Tubal ligation

  • Comprehensive elective service including hysterectomy and other pelvic surgery.

  • Vasetomy

  • Normal delivery (no co-morbidity)

  • Visual inspection

  • Full emergency urology services including ureteric obstruction

  • C-section (no co-morbidity)

General surgical
  • Comprehensive elective urology services including TURP and prostatectomy

  • Vacuum extraction/forceps

  • Repair of perforations (eg, peptic ulcer)

  • Manual vacuum aspiration and dilatation and curettage

  • Appendectomy

  • Full emergency orthopaedic services including internal fixation

  • Emergency hysterectomy for uterine rupture or intractable postpartum haemorrhage

  • Bowel obstruction

  • Comprehensive elective orthopaedic services including joint replacement

  • Salpingectomy for ruptured ectopic pregnancy

  • Colostomy

General surgical:
  • Gallbladder disease

  • Comprehensive emergency ENT coverage

  • Drainage of superficial abscess

  • Hernia elective and emergent

  • Elective ENT clinic

  • Male circumcision

  • Hydrocelectomy

Critical care:
  • Minor burn care

  • ICM levels III and IV

  • Wound care

  • Trauma laparotomy

  • Surgical infections

  • Fracture reduction

  • Local

  • Placement of external fixator and traction

  • Regional/spinal

  • Relief of urinary obstruction: urethral or suprapubic catheterisation

  • Escharotomy/fasciotomy

  • Emergency and elective general (all ASA—no difficult airway)

  • Skin graft

  • Paediatric <2 years

  • Basic resuscitation

  • Burr hole

  • Suture of laceration

  • Trauma amputation

  • Closed fracture reduction and stabilisation

**To assure quality, these are to be performed only if specified and HR and Infrastructure standards are met
  • Tube thoracostomy (chest drain)

Critical care:
  • Irrigation and debridement of open fractures

  • ICM level II

Critical care:Anaesthesia:
  • ICM level I

  • Elective and emergency general anaesthesia (ASA I–III)

  • Resuscitate

  • Regional/spinal anaesthesia

  • Protect airway

  • Local anaesthesia

  • Stabilisation and transfer a critically unwell patient

  • Paediatric 2 years and above

  • Spinal

  • Local

  • Emergency general anaesthesia (no co-morbidities)

  • *signifies multiplied by

  • ASA, American Society of Anaesthesiologists; ENT, ear nose throat; ICM, Intensive Care Medicine; NSOAP, National Surgical, Obstetric and Anesthesia Plan; OB-GYN, obstetrician-gynecologist; TURP, transurethral resection of the prostate.