Defining Surgical Workforce Density Targets to Meet Child and Neonatal Mortality Rate Targets in the Age of the Sustainable Development Goals: A Global Cross‐Sectional Study

Abstract

Objectives To reduce preventable deaths of newborns and children, the United Nations set a target rate per 1000 live births of 12 for neonatal mortality (NMR) and 25 for under-5 mortality (U5MR). The purpose of this paper is to define the minimum surgical workforce needed to meet these targets and evaluate the relative impact of increasing surgeon, anesthesia, and obstetrician (SAO) density on reducing child mortality. Methods We conducted a cross-sectional study of 192 countries to define the association between surgical workforce density and U5MR as well as NMR using unadjusted and adjusted B-spline regression, adjusting for common nonsurgical causes of childhood mortality. We used these models to estimate the minimum surgical workforce to meet the sustainable development goals (SDGs) for U5MR and NMR and marginal effects plots to determine over which range of SAO densities the largest impact is seen as countries scale-up SAO workforce. ResultsWe found that increased SAO density is associated with decreased U5MR and NMR (P \ 0.05), adjusting for common non-surgical causes of child mortality. A minimum SAO density of 10 providers per 100,000 population (95% CI: 7-13) is associated with an U5MR of \ 25 per 1000 live births. A minimum SAO density of 12 (95% CI: 9-20) is associated with an NMR of \ 12 per 1000 live births. The maximum decrease in U5MR, on the basis of our adjusted B-spline model, occurs from 0 to 20 SAO per 100,000 population. The maximum decrease in NMR based on our adjusted B-spline model occurs up from 0 to 18 SAO, with additional decrease seen up to 80 SAO. Conclusions Scale-up of the surgical workforce to 12 SAO per 100,000 population may help health systems meet the SDG goals for childhood mortality rates. Increases in up to 80 SAO/100,000 continue to offer mortality benefit for neonates and would help to achieve the SDGs for neonatal mortality reduction.

Prioritization of surgical, obstetric, trauma, and anesthesia care in India over seven decades: A systematic analysis of policy documents

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Delays in care for hydrocephalus and spina bifida at a tertiary hospital in Somaliland

“…From a policy standpoint, training neurosurgeons and other human resources and expanding the surgical infrastructure for children are fundamental steps in improving access to safe and timely neurosurgical care. This includes including surgical care for children in national health plans and recognizing the importance of children’s surgical care in attaining the United Nation’s Sustainable Development Goals 31 40 41. Telemedicine has been found to be a promising intervention in accelerating neurosurgical diagnosis and patient transfer in other resource constrained contexts 42–44.…”

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“…Notably, improving paediatric surgical care in LMICs can also impact global efforts towards achieving the sustainable development goals. 19 The limited paediatric surgical workforce and training capacity currently impede surgical access in India that had 1.29 paediatric surgeons per 1 000 000 people in the last decade; 14-fold and 23-fold less than the USA and the UK, respectively. 20 To inform policy change and encourage government engagement, a comprehensive subnational baseline assessment of India's surgical system is essential.…”

“…India needs to urgently take up paediatric surgical care in its health research and policy agenda, as it contains one of the largest paediatric populations globally with persistently high neonatal, infant and under-5 mortality rates. Notably, improving paediatric surgical care in LMICs can also impact global efforts towards achieving the sustainable development goals 19. The limited paediatric surgical workforce and training capacity currently impede surgical access in India that had 1.29 paediatric surgeons per 1 000 000 people in the last decade; 14-fold and 23-fold less than the USA and the UK, respectively 20…”