It has been demonstrated that very limited acute general surgery, as defined in the DHSP list, is performed at district level.
The DHSP list states that appendectomies and 'selected' laparotomies should be performed at district level.
However, rural district hospitals have been found to perform very few appendicectomies, laparotomies and other general surgery procedures listed in the DHSP
. (41) This was partially owing to the fact that the underlying pathology of an acute abdomen is often diagnosed intraoperatively, with some conditions treatable at district hospitals, and others requiring transfer to a higher level of care.
When pre-operative selection is unreliable the DHSP
requirement that district hospitals should do 'selected laparotomies' is meaningless.
Given the seriousness of the AIDS crisis and the perceived complicated design of CHAP, however, the original project was split into two projects--STIP, which was to focus specifically on STD and HIV interventions, and the District Health Services Pilot and Demonstration Project (DHSP
The STIP and the DHSP
should have been much better integrated.