Many patients who present to district (first-referral) level hospitals require surgical treatment for trauma, obstetric, abdominal and 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.
