Tool for Situational Analysis to Assess Emergency and Essential Surgical Care

Reference: WHO Integrated Management for Emergency & Essential Surgical Care (IMEESC) toolkit:
http://www.who.int/surgery/publications/imeesc/en/index.html

Objective: to assess the gaps in the availability of Emergency and Essential Surgical Care (EESC) at resource-constrained health facilities.

Facility Information
If you prefer to complete the paper version, Fields marked with an asterisk (*) are mandatory
please print and return this form
by email to cherianm@who.int or post or fax COUNTRY*
to the following address: DATE OF DATA COLLECTION*
(dd/mm/yyy)
Dr Meena Cherian NAME
Emergency & Essential Surgical Care program of person(s) filling out form*
Clinical Procedures Unit
PHONE NUMBER
Department of Health Systems Policies & Workforce
World Health Organization of person(s) filling out form*
20 Avenue Appia, 1211 EMAIL*
Geneva 27, Switzerland
Fax: 41 22 791 4836 www.who.int/surgery
NAME and ADDRESS
of health care facility*
(include city, state or province)

Phone number of health care

facility*

Health Subdistrict/ District/Rural Provincial General Private/NGO/Mission

Center Community Hospital Hospital Hospital Hospital Hospital
Type of health care facility

Section A: Infrastructure Insert number

1. Population served by this health care facility
2. Number of beds
3. Number of total admissions in one year
4. Number of total outpatients in one year
5. Number of total functioning operating rooms (major & minor)
6. Number of patients at this facility requiring major & minor surgical (including obs/gyn) procedures per year
7. Number of children (aged less than 15 years) at this facility requiring surgical procedures per year
8. Number of patients to this facility that you refer for surgical intervention to a higher level facility per year
9. How far (in km) does the average patient travel to get to your health facility for surgical services? (km)

10. If you do not provide surgical services, how far does the average patient travel to access surgical services? (km)

Fill in with either Not available, Sometimes or All the time Not Sometimes All the time
available
11. Do you have oxygen cylinder or concentrator supply with mask and tubing?
12. Do you have running water?
13. Do you have an electricity source/operational power generator?
14. Do you have a functioning anaesthesia machine?

WHO/HPW/CPR
 Fill in with either Not available, Sometimes or All the time Not Sometimes All the time
available
15. Do you keep medical records?
16. Do you have an area designated for Emergency care?
17. Do you have an area designated for Postoperative care?
18. Do you have management guidelines available for Emergency care?
19. Do you have management guidelines available for Surgery?
20. Do you have management guidelines available for Anaesthesia?
21. Do you have management guidelines available for Pain Relief?
22. Do you have a blood bank available at the facility?
23. Do you have a facility to test haemoglobin & urine?
24. Do you have a functioning X-ray machine available?
25. Do you have a functioning pulse oximeter available?

Section B: Human Resources

Number of Full Number of Part
Time Workers Time Workers
26. Surgeons (qualified)
27. Anaesthesiologist physicians (qualified)
28. Obstetricians/Gynecologists (qualified)
29. General doctors providing surgery (including obstetrics)
30. General doctors providing anaesthesia
31. Nurses/Clinical medical officers providing anaesthesia
32. Clinical medical officers providing surgery (including obstetrics)
33. Paramedics/Midwives

Section C: Interventions Do you perform these procedures?

If you refer, is it due to…
(circle ALL that apply)
Do you
Yes/No Non- Lack of
refer? Lack of
functioning supplies/
skills?
equipment? drugs?
34. Resuscitation (airway, hemorrhage, peripheral
percutaneous intravenous access, peripheral venous cut Y N Y N Y N Y N Y N
down)
35. Cricothyroidotomy/Tracheostomy Y N Y N Y N Y N Y N
36. Chest tube insertion Y N Y N Y N Y N Y N
37. Removal of foreign body (throat/eye/ear/nose) Y N Y N Y N Y N Y N
38. Acute burn management Y N Y N Y N Y N Y N
39. Incision & drainage of abscess Y N Y N Y N Y N Y N
40. Suturing (for wounds, episiotomy, cervical & vaginal
Y N Y N Y N Y N Y N
lacerations)
41. Wound debridement Y N Y N Y N Y N Y N
42. Caesarean section Y N Y N Y N Y N Y N
43. Dilatation & curettage/vacuum extraction (obstetrics/gyn) Y N Y N Y N Y N Y N

WHO/HPW/CPR
Section C: Interventions Do you perform these procedures?
If you refer, is it due to…
(circle ALL that apply)
Do you
Yes/No Non- Lack of
refer? Lack of
functioning supplies/
skills?
equipment? drugs?
44. Obstetric fistula repair Y N Y N Y N Y N Y N
45. Tubal ligation/vasectomy Y N Y N Y N Y N Y N
46. Biopsy (lymph node, mass, other) Y N Y N Y N Y N Y N
47. Appendectomy Y N Y N Y N Y N Y N
48. Hernia repair (strangulated, elective, congenital) Y N Y N Y N Y N Y N
49. Hydrocelectomy Y N Y N Y N Y N Y N
50. Cystostomy Y N Y N Y N Y N Y N
51. Urethral stricture dilatation Y N Y N Y N Y N Y N
52. Laparotomy (uterine rupture, ectopic pregnancy, acute
Y N Y N Y N Y N Y N
abdomen, intestinal obstruction, perforation, injuries)
53. Male circumcision Y N Y N Y N Y N Y N
54. Neonatal surgery: abdominal wall defect, colostomy
Y N Y N Y N Y N Y N
imperforate anus, intussusceptions
55. Cleft lip repair Y N Y N Y N Y N Y N
56. Clubfoot repair Y N Y N Y N Y N Y N
57. Contracture release/skin grafting Y N Y N Y N Y N Y N
58. Closed treatment of fracture Y N Y N Y N Y N Y N
59. Open treatment of fracture Y N Y N Y N Y N Y N
60. Joint dislocation treatment Y N Y N Y N Y N Y N
61. Drainage of osteomyelitis/septic arthritis Y N Y N Y N Y N Y N
62. Amputation Y N Y N Y N Y N Y N
63. Cataract surgery Y N Y N Y N Y N Y N
64. Regional anaesthesia blocks Y N Y N Y N Y N Y N
65. Spinal anaesthesia Y N Y N Y N Y N Y N
66. Ketamine intravenous anaesthesia Y N Y N Y N Y N Y N
67. General anaesthesia inhalational Y N Y N Y N Y N Y N

Section D: Emergency & Essential Surgical Care Equipment and Supplies

For details refer to WHO IMEESC toolkit www.who.int/surgery/publications/imeesc; WHO ETC guidelines
www.who.int/violence_injury_prevention/services; WHOEML www.who.int/medicines/publications

0 1 2
absent available with frequent fully available for
shortages or difficulties all patients all the time
Capital Outlays
68. Resuscitator bag valve & mask (adult)
69. Resuscitator bag valve & mask (pediatric)
70. Stethoscope
71. Suction pump (manual or electric) with catheter
72. Blood pressure measuring equipment
73. Thermometer
74. Scalpel with blades
75. Retractor

WHO/HPW/CPR
 0 1 2
absent available with frequent fully available for
shortages or difficulties all patients all the time
76. Scissors
77. Oropharyngeal airway (adult size)
78. Oropharyngeal airway (pediatric size)
79. Forceps, artery
80. Gloves (sterile)
81. Gloves (examination)
82. Needle holder
83. Sterilizer
84. Vaginal speculum
Renewable Items
85. Nasogastric tubes
86. Light source (lamp & flash light)
87. Intravenous fluid infusion set
88. Intravenous cannulas/scalp vein infusion set
89. Syringes with needles (disposable)
90. Sharps disposal container
91. Tourniquet
92. Needles & sutures
93. Splints for arm, leg
94. Urinary catheters (Foleys disposable)
95. Waste disposal container
96. Face masks
97. Eye protection
98. Protective gowns/aprons
99. Soap
Supplementary equipment for use by skilled health professionals
100. Magill forceps (adult)
101. Magill forceps (pediatric)
102. Endotracheal tubes (adult)
103. Endotracheal tubes (pediatric)
104. IV infusor bags
105. Chest tubes insertion equipment
106. Laryngoscope Macintosh blades with bulbs &
batteries (adult)
107. Laryngoscope Macintosh blades with bulbs &
batteries (pediatric)
108. Cricothyroidotomy set

THANK YOU FOR YOU TAKING THE TIME TO COMPLETE THIS FORM

WHO/HPW/CPR