The World Health Organisation (WHO) has come out with a list of essential surgical care items for district level hospitals in the developing countries. The Department of Blood Safety and Clinical Technology of the WHO have listed the items in its latest edition of "Surgical Care at the District Hospital".

The department has a mission to promote the quality of clinical care through the identification, promotion and standardization of appropriate procedures, equipment and materials, particularly at district hospital level. The department has identified education and training as a particular priority, especially for non-specialist practitioners who practice surgery and anaesthesia.

The manual, which contains a generic list of essential emergency equipment linked to the procedures at 3 levels of health facilities, is to prove useful to individual practitioners and for use in undergraduate and postgraduate programmes, in-service training and continuing medical education programmes.

The WHO has found that many patients who reach district (first-referral) level hospitals require surgical treatment for trauma, obstetric, abdominal or orthopaedic emergencies.

"Often surgery cannot be safely postponed to allow their transfer to a secondary or tertiary-level hospital, but many district hospitals in developing countries have no specialist surgical teams and are staffed by medical, nursing and paramedical personnel who perform a wide range of surgical procedures, often with inadequate training. The quality of surgical and acute care is often further constrained by poor facilities, inadequate low-technology apparatus and limited supplies of drugs, materials and other essentials." It has noted.

The WHO manual provides a practical guide to surgical procedures that are commonly performed by non-specialist clinicians working in district hospitals (1st level referral hospitals) with limited resources. The objective of this manual is to improve the quality of clinical care at the district hospital particularly in essential procedures in surgery, obstetrics, gynaecology, orthopaedics, anaesthesia and trauma.

"Often, the poor organization and inadequate resourcing of 1st level referral hospitals contributes to unacceptable rates of mortality in surgical and obstetrical procedures. This manual includes a comprehensive guide to the organization of the district surgical service, management of equipment and infection control" WHO has stated.

This WHO manual on Surgical Care at the District Hospital has been written by an international team of specialists and reviewed by clinical specialists from all parts of the world. WHO departments of Reproductive Health and Research (MPR), Health Service Provision, Child and Adolescent Health (CAH), and Injuries and Violence Prevention (VIP) have also reviewed the manual.

The manual is a successor of three earlier publications that are widely used throughout the world and that remain important reference texts: General Surgery at the District Hospital (WHO, 1988), Surgery at the District Hospital: Obstetrics Gynaecology,Orthopaedics and Traumatology (WHO, 1991) and Anaesthesia at the District Hospital (WHO, 1988; second edition 2000). This new manual draws together material from these three publications into a single volume which includes new and updated material, as well as material from Managing Complications in Pregnancy and Childbirth: A Guide for Midwives and Doctors (WHO, 2000).