Optimal Resources for Children's Surgery 2: Essential Human Resources for Optimal Children's Surgery.

Background

Following its inaugural meeting at the Royal College of Surgeons of England, London, United Kingdom, in 2016, the Global Initiative for Children's Surgery (GICS) published the Optimal Resources for Children's Surgery 1 (OReCS) consensus document detailing the facilities and resources required at each level of care. In addition to physical resources needed to provide care for children, the Lancet Commission on Global Surgery (LCoGS) identified the density of surgical providers as a marker of sufficient workforce in capacity. To meet the needs of patients, OReCS 2 details the varying types of providers needed at each level of care to meet the minimum expected capacity to care for children with surgical needs.

Methods

We performed a review of the literature and reviewed LCoGS recommendations that applied solutions in low resource settings. We then used an iterative Delphi-like approach to determine the types of providers needed for each of 13 sub-specialties in children's surgical care at the different hospital levels. Participation was open to all GICS V conference attendees that were held from 24 to 26 February 2024 in Manila Philippines. This represents 441 participants from 50 countries (79% low to middle income countries). Final recommendations were made based on a greater than 75% agreement by respondents and reviewed by the 20 GICS board of directors.

Results

In the current literature, there is considerable variability in the provider types described for each facility level with an emphasis on the use of non-physician health workers such as clinical officers, nurse anesthetists, and community health workers to improve access. Using the modified Delphi from GICS V, it is recommended to have a generalist medical practitioner, followed by non-physician surgical providers at the health center level. First level hospitals should have generalist medical practitioner, non-physician surgical provider, and generalist medical practitioner with pediatric-specific training. At the referring hospital level, which includes 2nd level hospital, third level hospital, and children's hospital, recommendations are generalist medical practitioner (GMP), non-physician surgical providers (NPSP), pediatric general and specialty surgeons, and some medical specialists such as cardiologist, gastroenterologist, and others, for maximum care coverage.

Conclusions

To improve access to high-quality care and perform the procedures considered essential, different types of providers are needed at different facility levels. Ranging from community health workers to surgical subspecialists to nurses with expertise in pediatric intensive care units to physiotherapists. OReCS 2 provides detailed examples of the optimal human resources and workforce needed at each facility level.