Impact of COVID-19 on the cost of surgical and obstetric care: experience from a Nigerian teaching hospital and a review of the Nigerian situation.

The public health impact of the COVID-19 pandemic cannot be overstated. Its impact on the cost of surgical and obstetric care is significant. More so, in a country like Nigeria, where even before the pandemic, out-of-pocket spending (OOPS) has been the major payment method for healthcare. The increased cost of surgical and obstetric care occasioned by the pandemic has principally been due to the additional burden of ensuring the use of adequate/appropriate personal protective equipment (PPE) during patient care as a disease containment measure. These PPE are not readily available in public hospitals across Nigeria. Patients are therefore compelled to bear the financial burden of procuring scarce PPE for use by health care personnel, further increasing the already high cost of healthcare. In this study, we sought to appraise the impact of the COVID-19 pandemic on the cost of surgical and obstetric care in Nigeria, drawing from the experience from one of the major Nigerian teaching hospitals- the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Osun State. The cost of surgical and obstetric care was reviewed and compared pre- and during the COVID-19 pandemic, deriving relevant examples from some commonly performed surgical operations in our centre (OAUTHC). We reviewed patients' hospital bills and receipts of consumables procured for surgery. Our findings revealed that the cost of surgical and obstetric care during the COVID-19 pandemic had significantly increased. We identified gaps and made relevant recommendations on measures to reduce the additional costs of surgical and obstetric care during and beyond pandemic.

Impact of the COVID-19 Pandemic on Surgical Residency Training: Perspective from a Low-Middle Income Country.

BACKGROUND: The COVID-19 pandemic has drastically impacted postgraduate training programmes worldwide. This study aims to evaluate the Nigerian situation with respect to surgical training, with a view to identifying gaps and proffering solutions. METHODS: A cross-sectional survey of surgical residents in Nigeria was conducted between 27 July 2020 and 14 August 2020. A structured questionnaire designed using the free software Google Forms® was utilised for the study. The questionnaire was electronically distributed randomly to 250 surgical residents via emails and social media platforms including WhatsApp and Telegram. The data obtained was analysed by Google Forms®. Ethical approval for the study was obtained from the ethics and research unit of the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Osun State, Nigeria. RESULTS: At the end of the study period, 207 surgical residents completed and submitted the questionnaire, giving a response rate of 82.8%. The majority of respondents reported a reduction (164, 79.2%) or cancellation (11, 5.3%) of postgraduate programmes in their institutions. Of those who had academic programmes, meetings were done using virtual technology in all instances. The majority of respondents reported seeing fewer patients in the outpatient clinics (173, 83.6%), as well as a reduction in the number of emergency and elective operations (58.5% and 90.8%, respectively). About a third of the respondents (70, 33.8%) were contemplating emigrating from the country. CONCLUSION: The COVID-19 pandemic has significantly affected the clinical, research and teaching components of surgical training in Nigeria. It has, however, led to increased adoption of digital technology which should be further explored in the face of current realities.