Essential surgeries can be available, even in the most basic of conditions, with the adoption of three simple but radical innovations: power-independent anesthesia, instrument sterilization that does not require heat or power and task shifting (surgery by non-surgeons).
A surgery can be shifted or a break can be scheduled between two surgeries.
For each of the scenario's, we determine how often one of the following adjustments occurred: (i) shifting a surgery, (ii) exchanging the sequence of two surgeries, and (iii) canceling a surgery.
By applying this ILP to instances from practice, we determined that the given preferences mainly lead to (i) shifting a surgery and (ii) scheduling a break between two surgeries.
> Table 2 shows that shifting a surgery is the most frequent adjustment used, and often we see that a break is scheduled between two surgeries.
Task shifting in surgery is a little trickier.
Ohta also recommended a single 8 0 nylon suture should be used to fix the haptic to the scleral bed to prevent it from shifting after surgery.
Task shifting in surgery was limited to surgical toilet, episiotomies, incision and drainage of abscesses, setting up intravenous drips, anaesthesia, and of recent but not extensively done – medical male circumcision.
However, this is not expected in hospitals that have a similar group of stakeholders as the Isala Clinics, because these two adjustments are less preferred than shifting a surgery.
Shifting obstetric surgery, anesthesia, and abortion tasks to midwives may also be worthy of consideration, as this has been shown to be an effective strategy for optimizing health worker roles in other settings [ 24].
