Abstract:ObjectiveTo assess the consistent availability of basic surgical resources at selected facilities in seven countries.MethodsIn 2010–2014, we used a situational analysis tool to collect data at district and regional hospitals in Bangladesh (n = 14), the Plurinational State of Bolivia (n = 18), Ethiopia (n = 19), Guatemala (n = 20), the Lao People's Democratic Republic (n = 12), Liberia (n = 12) and Rwanda (n = 25). Hospital sites were selected by pragmatic sampling. Data were geocoded and then analysed using an online data visualization platform. Each hospital’s catchment population was defined as the people who could reach the hospital via a vehicle trip of no more than two hours. A hospital was only considered to show consistent availability of basic surgical resources if clean water, electricity, essential medications including intravenous fluids and at least one anaesthetic, analgesic and antibiotic, a functional pulse oximeter, a functional sterilizer, oxygen and providers accredited to perform surgery and anaesthesia were always available.FindingsOnly 41 (34.2%) of the 120 study hospitals met the criteria for the provision of consistent basic surgical services. The combined catchments of the study hospitals in each study country varied between 3.3 million people in Liberia and 151.3 million people in Bangladesh. However, the combined catchments of the study hospitals in each study country that met the criteria for the provision of consistent basic surgical services were substantially smaller and varied between 1.3 million in Liberia and 79.2 million in Bangladesh.ConclusionMany study facilities were deficient in the basic infrastructure necessary for providing basic surgical care on a consistent basis.

Surgical capacity varies throughout Bolivia. There are relatively large numbers of surgery providers but an insufficient number of anesthesiologists, suggesting a specific need for further development in anesthesia. Though there are many areas of strength within the Bolivian public health-care system, this survey identified several areas to which national policy and international collaboration can contribute in order to more adequately address major causes of surgical morbidity and mortality.

IntroductionAccess to emergency and essential surgery is integral to a comprehensive health-care system. Since the development of the millennium development goals, the global health community has increasingly recognized the role of surgical care in the treatment of common conditions such as acute abdominal processes, obstetric complications and trauma. 1 Surgical conditions are estimated to account for 18% of the global burden of disease. 2 However, in low-and middle-income countries there is often inadequate surgical capacity. In 2015, it was estimated that at least 143 million additional operations would be required to address emergency and essential surgical conditions in such countries. 3 In the same year, the Lancet Commission on Global Surgery noted that 5 billion people did not have access to affordable, safe and/or timely surgical care 3 and, each year, such lack of access results in an estimated 1.5 million avoidable deaths. 2 The Lancet Commission also proposed six key indicators to define and measure the availability and affordability of surgical care for a given population 3 -including case volume, the density of the surgical specialist workforce, perioperative mortality and timely access. Since 2011, several of these key indicators have been investigated. [4][5][6][7][8] The impetus to understand and implement the basic components of the provision of quality surgical care is stronger than ever. With the recent implementation of the United Nation's sustainable development agenda for 2030, 9 there is renewed opportunity to focus on expanding universal healthcare coverage to include essential surgical services. Moreover, to achieve sustainable development goal 3 -i.e. ensuring healthy lives and promoting well-being for all at all ages -a more detailed understanding of the calibre of the surgical care available in low-and middle-income countries is necessary. The substantial and often alarming variability observed in sur-Objective To assess the consistent availability of basic surgical resources at selected facilities in seven countries. Methods In 2010-2014, we used a situational analysis tool to collect data at district and regional hospitals in Bangladesh (n = 14), the Plurinational State of Bolivia (n = 18), Ethiopia (n = 19), Guatemala (n = 20), the Lao People's Democratic Republic (n = 12), Liberia (n = 12) and Rwanda (n = 25). Hospital sites were selected by pragmatic sampling. Data were geocoded and then analysed using an online data visualization platform. Each hospital's catchment population was defined as the people who could reach the hospital via a vehicle trip of no more than two hours. A hospital was only considered to show consistent availability of basic surgical resources if clean water, electricity, essential medications including intravenous fluids and at least one anaesthetic, analgesic and antibiotic, a functional pulse oximeter, a functional sterilizer, oxygen and providers accredited to perform surgery and anaesthesia were always available. Findings Only 41 (34.2%) of the 120 stud...