Essential Surgery: The Way Forward

Henry, Jaymie; Bem, Chris; Grimes, Caris; Borgstein, Eric; Mkandawire, Nyengo; Thomas, W. E. G.; Gunn, S. William A.; Lane, Robert H.; Cotton, Michael

doi:10.1007/s00268-014-2937-9

Cited by 33 publications

(33 citation statements)

References 103 publications

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“…[17] It can also improve quality-of-life,[18–20] time-use,[20] and social status[19] and positively impacts on poverty alleviation. [18–20] These strengths and benefits have contributed to the inclusion of cataract surgery in recent essential surgery lists,[21, 22] as well as in the proposed initial surgical package for UHC. [23] Cataract surgery can, however, be associated with poor visual outcomes for several reasons.…”

Section: Introductionmentioning

confidence: 99%

Effective cataract surgical coverage: An indicator for measuring quality-of-care in the context of Universal Health Coverage

et al. 2017

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Objective To define and demonstrate effective cataract surgical coverage (eCSC), a candidate UHC indicator that combines a coverage measure (cataract surgical coverage, CSC) with quality (post-operative visual outcome). Methods All Rapid Assessment of Avoidable Blindness (RAAB) surveys with datasets on the online RAAB Repository on April 1 2016 were downloaded. The most recent study from each country was included. By country, cataract surgical outcome (CSOGood, 6/18 or better; CSOPoor, worse than 6/60), CSC (operated cataract as a proportion of operable plus operated cataract) and eCSC (operated cataract and a good outcome as a proportion of operable plus operated cataract) were calculated. The association between CSC and CSO was assessed by linear regression. Gender inequality in CSC and eCSC was calculated. Findings Datasets from 20 countries were included (2005–2013; 67,337 participants; 5,474 cataract surgeries). Median CSC was 53.7% (inter-quartile range[IQR] 46.1–66.6%), CSOGood was 58.9% (IQR 53.7–67.6%) and CSOPoor was 17.7% (IQR 11.3–21.1%). Coverage and quality of cataract surgery were moderately associated—every 1% CSC increase was associated with a 0.46% CSOGood increase and 0.28% CSOPoor decrease. Median eCSC was 36.7% (IQR 30.2–50.6%), approximately one-third lower than the median CSC. Women tended to fare worse than men, and gender inequality was slightly higher for eCSC (4.6% IQR 0.5–7.1%) than for CSC (median 2.3% IQR -1.5–11.6%). Conclusion eCSC allows monitoring of quality in conjunction with coverage of cataract surgery. In the surveys analysed, on average 36.7% of people who could benefit from cataract surgery had undergone surgery and obtained a good visual outcome.

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Section: Introductionmentioning

confidence: 99%

Effective cataract surgical coverage: An indicator for measuring quality-of-care in the context of Universal Health Coverage

et al. 2017

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“…Compiling several studies, the current literature suggests focusing on five key factors: in-frastructure, workforce, service delivery, financing, and information management (Meara et al, 2015;O'Hara, 2015;Henry et al, 2015). Tackling the challenges associated with inaccessible surgical care is imperative to move forward.…”

Section: Recommendationsmentioning

confidence: 99%

“…A stemming issue is the availability of trained physicians and anaesthesiologists. For instance, Rwanda has 50 surgeons for 11 million individuals and Burundi has only 15 surgeons for ten million individuals (Henry et al, 2015).…”

Section: Work Force Service Delivery and Managementmentioning

confidence: 99%

“…The deficits in the workforce are based on a number of factors relating to the underfunding of health facilities, poor remuneration, poor retirement provision, lack of postgraduate training, and civil unrest (Pang, Lansang, & Haines, 2002;Cometto, Tulenko, Muula, & Krech, 2013). In some district hospitals in Mozambique, Tanzania, and Uganda, surgical and anaesthetic care is provided by medical attendants rather than trained physicians who do not have adequate knowledge and training to handle medical crises (Grimes et al, 2011;Henry et al, 2015). Another major burden on the health care system and educational system is the "brain drain" phenomenon, whereby medical professionals from developing countries migrate to developed nations.…”

Section: Work Force Service Delivery and Managementmentioning

confidence: 99%

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The Global Burden of Surgical Disease: An Analysis on Inaccessible Surgical Care in Low and Middle Income Countries

Huynh

2018

RISS-IJHS

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Résumé :(traduction) À l'échelle mondiale, 4,8 milliards de personnes n'ont pas accès à des soins chirurgicaux ni à une gestion de l'anesthésie sécuritaires ou adéquats. Les soins chirurgicaux sont considérés comme « le parent pauvre de la santé mondiale »; un rappel frappant des disparités en matière de soins de santé. Les interventions chirurgicales peuvent prévenir 11 pour cent de la charge mondiale de morbidité et 1,5 million de morts annuellement. Cependant, de nombreux obstacles empêchent les pays à revenu faible et intermédiaire (PRFI) d'accéder à des soins chirurgicaux. Le premier défi consiste à offrir des soins chirurgicaux efficients malgré les restrictions financières et les bouleversements politiques. De l'aide étrangère a été mise en place pour alléger le fardeau financier et ses contributions ont été essentielles. Mais dans certains pays, en raison du climat politique, les fonds destinés au domaine de la santé sont détournés vers d'autres secteurs du gouvernement. De plus, le manque d'infrastructure, d'équipement et de personnel dans les PRFI aggrave la situation. Le second défi consiste à déterminer si une intervention chirurgicale est possible et aussi efficace qu'une intervention non chirurgicale. Les soins chirurgicaux sont essentiels et cet article vise à évaluer quels sont les obstacles qui limitent l'importance qu'on leur accorde dans les discussions portant sur la santé mondiale. Cet article abordera l'impact du financement, de l'infrastructure, de la main-d'oeuvre, de la prestation de service et de la gestion de l'information sur les soins chirurgicaux, ainsi que les solutions actuelles telles que les missions d'aide humanitaire. Mots-clés :Services de santé, pays à revenu faible et intermédiaire, chirurgie 9 Abstract:Worldwide, 4.8 billion people do not have access to safe, adequate surgical care and anaesthetic management. Surgical care has been deemed "the neglected child of global health," a startling reminder of the disparities in health services. The provision of surgical interventions can avert 11% of the global burden of disease and 1.5 million deaths each year. Many obstacles exist for low-and middle-income countries (LMIC) to progress towards accessible surgical care. The first challenge is delivering cost-effective surgical care despite financial constraints and political turmoil. Foreign aid was established to alleviate the financial burden and its contributions have been pivotal. However, based on the political climate in certain countries, funds are siphoned to government sectors other than health care. Moreover, the lack of infrastructure, equipment, and personnel in LMIC compound the issue. The other challenge is determining if surgery is as feasible and effective as non-surgical health interventions. Surgical care is crucial and this paper aims to assess the challenges that limit its stature in global health discussions. The paper will address the influence of financing, infrastructure, workforce, service delivery, and information management on surgical care, and the curr...

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“…Despite the fact that 2 out of every 7 people on the planet lack access to life saving and life changing surgeries, the situation is largely unknown and unrecognized by the global health community. Even less recognition is given to the viable and simple solutions available to address neglected surgical diseases [2].…”

mentioning

confidence: 99%