Evaluation of Interventions Addressing Timely Access to Surgical Care in Low‐Income and Low‐Middle‐Income Countries as Outlined by the LANCET Commission 2030 Global Surgery Goals: A Systematic Review

Abstract

Background In 2015, the Lancet Commission on Global Surgery published six global surgery goals, one of which was to provide 80% of the world's population with timely access to the Bellwether Surgical procedures. Little is known about the prevalence or efficacy of subsequent interventions implemented in under‐resourced countries to increase timely access to Bellwether surgical procedures. Methods A systematic review of articles and grey literature published in MEDLINE, Embase, Cochrane, CINAHL, and Web of Science databases was conducted. Two independent reviewers evaluated 1923 captured abstracts using explicit inclusion and exclusion criteria. Following a thematic analysis, two reviewers conducted data extraction on the eleven manuscripts included in the final review. Results The studied innovations, sparse in number, centred on improved educational resources, the development of orthopaedic devices, and models for assessing surgical access disparity. Eight papers were centred around timely access to caesarean sections, three around open fracture reduction, and three around laparotomy; all focused on adult populations. Five papers addressed innovations in West Africa, two in East Africa, two in South Asia, and one in Southeast Asia. Common outcome metrics were not used to assess improvements to timely surgical access. Conclusions Few published interventions have been implemented since the publication of the 2015 Lancet Commission on Global Surgery goals that have or will longitudinally increase the availability of timely surgical access in Low and Middle‐Income Countries (LMIC). Tangible outcome measures in existing literature are lacking. An up‐scaling and wider adoption of successful strategies is necessary and possible.

Association between ambulance prehospital time and maternal and perinatal outcomes in Sierra Leone: a countrywide study

“…3 5 At present, however, little is known regarding the compliance to this target in LICs, and the few studies available show that serious gaps exist in accessing emergency obstetric surgical care within the above-mentioned time frame. [6][7][8][9][10] To this regard, it is broadly acknowledged that poorly developed transportation infrastructure, lack of ambulance systems and geographical barriers play a major role in the so-called 'second delay'-the delay in reaching care-described in the Three Delays framework, 3 thus limiting access to timely emergency care in these countries. 11 In the past 10 years, many sub-Saharan African countries have tried to develop emergency medical services (EMS) with the aim of providing prehospital care alongside prompt and safe transport to hospitals, in particular for obstetric emergencies.…”

“…In its 2015 report, the Lancet Commission on Global Surgery proposed to measure access to timely and essential surgery using the proportion of population that can access essential surgical resources, defined as the Bellwether procedures, within a 2-hour travel time (TT), an indicator that was also included in the WHO 100 Core Global Health Indicators 3 5. At present, however, little is known regarding the compliance to this target in LICs, and the few studies available show that serious gaps exist in accessing emergency obstetric surgical care within the above-mentioned time frame 6–10. To this regard, it is broadly acknowledged that poorly developed transportation infrastructure, lack of ambulance systems and geographical barriers play a major role in the so-called ‘second delay’—the delay in reaching care—described in the Three Delays framework,3 thus limiting access to timely emergency care in these countries 11…”

An Online, Modular Curriculum Enhances Surgical Education and Improves Learning Outcomes in East, Central, and Southern Africa: A Mixed-Methods Study

“…Surgical education is a vital component of expanding access to surgical care in low-and middle-income countries (LMICs) [1][2][3][4] as increasing the surgical workforce remains a key intervention priority for sub-Saharan Africa. 3 Tailored curricular activities have been determined to be a necessary part of improving surgical education in LMICs like those in East, Central, and Southern Africa (ECSA).…”

Elective Courses in Global Surgery for Undergraduate Medical Students: A Narrative Review and a Proposal for European Universities

“…68.15, 10 and were later revised and updated. 11,12 Since the report of the LCoGS, GS has extensively grown in consensus within the GH community. 13 Nevertheless, the goal of ensuring universal access to surgical care is yet to be achieved.…”