Evaluating Progress in the Global Surgical Crisis: Contrasting Access to Emergency and Essential Surgery and Safe Anesthesia Around the World

Merchant, Amina; Hendel, Simon; Shockley, Ross; Schlesinger, Joseph J.; Vansell, H.J.; McQueen, Kelly

doi:10.1007/s00268-015-3179-1

Cited by 24 publications

(26 citation statements)

References 11 publications

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“…Medical directors provided permission for the researchers to tour relevant infrastructure, including the study hospitals’ pharmacies, operating rooms and wards. Audits were documented using an abbreviated version of the World Health Organization’s (WHO’s) Global Initiative for Emergency and Essential Surgical Care survey questionnaire 7 , 12 , 13 . More detailed descriptions of this questionnaire are included in the reports of previous country-specific investigations 4 – 8 …”

Section: Methodsmentioning

confidence: 99%

A geospatial evaluation of timely access to surgical care in seven countries

Knowlton

Banguti

Chackungal

et al. 2017

Bull. World Health Organ.

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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.

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Section: Methodsmentioning

confidence: 99%

A geospatial evaluation of timely access to surgical care in seven countries

Knowlton

Banguti

Chackungal

et al. 2017

Bull. World Health Organ.

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“…Audits were documented using an abbreviated version of the World Health Organization's (WHO's) Global Initiative for Emergency and Essential Surgical Care survey questionnaire. 7,12,13 More detailed descriptions of this questionnaire are included in the reports of previous country-specific investigations. [4][5][6][7][8] The Lancet Commission on Global Surgery proposed dimensions for access that included affordability, safety and timeliness.…”

Section: Methodsmentioning

confidence: 99%

“…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.…”

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confidence: 99%

“…The district hospital is expected to provide emergency and essential surgery and serve as the nexus of surgical services that do not require referral to specialized centres for tertiary care. [4][5][6][7][8]11 While many district hospitals provide simple and essential surgical procedures, the resources and materials available to provide safe care are frequently inadequate. We decided to assess the difference in access to essential surgical services when minimum resource standards are included in the calculation of surgical availability.…”

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confidence: 99%

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A geospatial evaluation of timely access to surgical care in seven countries

Knowlton¹,

Banguti²,

Chackungal³

et al. 2017

WIDER Working Paper

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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...

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“…Patients for emergency cesarean delivery often waited hours and anesthesia personnel availability was a frequent limitation. Access to emergency obstetric surgery has been cited as an indicator of the overall surgical capacity of a health system (14, 15). …”

Section: Background and Rationalementioning

confidence: 99%

Where Are They Now? Evolution of a Nurse Anesthesia Training School in Ghana and a Survey of Graduates

Potisek

Hatch

Atito-Narh

et al. 2017

Front. Public Health

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Ghana, like other countries in sub-Saharan African, has limited access to surgery. One contributing factor is the inadequate number of anesthesia providers. To address this need, Kybele, Inc., a US-based non-governmental organization, partnered with the Ghana Health Service to establish the third nurse anesthesia training school (NATS) in Ghana. The school, based at Ridge Regional Hospital (RRH) in Accra, opened in October 2009. This paper describes the evolution of the training program and presents the curriculum. Second, the results of a voluntary survey conducted among the first four classes of graduates (2011–2014) are presented to determine their perceived strengths and gaps in training and to identify employment locations and equipment availability. Seventy-five of 93 graduates (81%) responded to the survey. The graduates reported working in 39 hospitals across 7 of the 10 regions in Ghana. Six providers (8%) worked alone and 16 (21%) were one of only two providers. Fifty-three providers (71%) had no physician anesthesiologist at their facility. Most providers had access to basic anesthesia equipment; however, there was limited access to emergency airway equipment. While most graduates felt that their training had prepared them for their current positions, 21% reported experiencing a patient death during anesthesia. The NATS at RRH has been sustained and most of the graduates are working in Ghana, filling an important void. Quality improvement and continuing education must be emphasized in an effort to reduce surgical morbidity and mortality in Ghana.

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Evaluating Progress in the Global Surgical Crisis: Contrasting Access to Emergency and Essential Surgery and Safe Anesthesia Around the World

Cited by 24 publications

References 11 publications

A geospatial evaluation of timely access to surgical care in seven countries

A geospatial evaluation of timely access to surgical care in seven countries

A geospatial evaluation of timely access to surgical care in seven countries

Where Are They Now? Evolution of a Nurse Anesthesia Training School in Ghana and a Survey of Graduates

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