Mapping Population-Level Spatial Access to Essential Surgical Care in Ghana Using Availability of Bellwether Procedures

Abstract

IMPORTANCE Conditions that can be treated by surgery comprise more than 16% of the global disease burden. However, 5 billion people do not have access to essential surgical care. An estimated 90% of the 87 million disability-adjusted life-years incurred by surgical conditions could be averted by providing access to timely and safe surgery in low-income and middle-income countries. Population-level spatial access to essential surgery in Ghana is not known. OBJECTIVES To assess the performance of bellwether procedures (ie, open fracture repair, emergency laparotomy, and cesarean section) as a proxy for performing essential surgery more broadly, to map population-level spatial access to essential surgery, and to identify first-level referral hospitals that would most improve access to essential surgery if strengthened in Ghana. DESIGN, SETTING, AND PARTICIPANTS Population-based study among all households and public and private not-for-profit hospitals in Ghana. Households were represented by georeferenced census data. First-level and second-level referral hospitals managed by the Ministry of Health and all tertiary hospitals were included. Surgical data were collected from January 1 to December 31, 2014. MAIN OUTCOMES AND MEASURES All procedures performed at first-level referral hospitals in Ghana in 2014 were used to sort each facility into 1 of the following 3 hospital groups: those without capability to perform all 3 bellwether procedures, those that performed 1 to 11 of each procedure, and those that performed at least 12 of each procedure. Candidates for targeted capability improvement were identified by cost-distance and network analysis. RESULTS Of 155 first-level referral hospitals managed by the Ghana Health Service and the Christian Health Association of Ghana, 123 (79.4%) reported surgical data. Ninety-five (77.2%) did not have the capability in 2014 to perform all 3 bellwether procedures, 24 (19.5%) performed 1 to 11 of each bellwether procedure, and 4 (3.3%) performed at least 12. The essential surgical procedure rate was greater in bellwether procedure–capable first-level referral hospitals than in noncapable hospitals (median, 638; interquartile range, 440–1418 vs 360; interquartile range, 0–896 procedures per 100 000 population; P = .03). Population-level spatial access within 2 hours to a hospital that performed 1 to 11 and at least 12 of each bellwether procedure was 83.2% (uncertainty interval [UI], 82.2%–83.4%) and 71.4% (UI, 64.4%–75.0%), respectively. Five hospitals were identified for targeted capability improvement. CONCLUSIONS AND RELEVANCE Almost 30% of Ghanaians cannot access essential surgery within 2 hours. Bellwether capability is a useful metric for essential surgery more broadly. Similar strategic planning exercises might be useful for other low-income and middle-income countries aiming to improve access to essential surgery.

Access to emergency hospital care provided by the public sector in sub-Saharan Africa in 2015: a geocoded inventory and spatial analysis

“…We generated a travel impedance surface by assigning travel speeds of 100 km/h to primary roads, 50 km/h to secondary roads, and 30 km/h to tertiary roads on the basis of previous studies. 18 , 19 The model does not give any measures of uncertainty; and for sensitivity analysis, we varied the motorised speeds by more or less than 20% of the original speeds 19 , 20 to define an upper and lower bound of uncertainty around travel speeds. We assigned the other non-road raster cells with speeds of 5 km/h, assuming patients could walk, were carried, or were transported with use of other means to the nearest road before obtaining motorised travel.…”

Geospatial relationship of road traffic crashes and healthcare facilities with trauma surgical capabilities in Nairobi, Kenya: defining gaps in coverage

“…A macro-level study of nine countries showed that the proportion of a country’s population living within a 2-hour drive of essential surgical services varied from 17% (Somaliland) to 84% (Pakistan). 11 Studies in Zambia 12 and Ghana 13 have attempted to use more granular mapping techniques to estimate countrywide access to surgical services and inform health systems planning. Of note, the Ghana study was able to identify five health facilities which were already providing some surgical services and had large catchment areas, making them ideal ‘targets’ for the expansion of their surgical services to increase timely access to care.…”

Universal access to safe, affordable, timely surgical and anaesthetic care in Papua New Guinea: the six global health indicators

“…By reporting the six Global Health indicators for APH and Milne Bay Province, our team have developed a methodology that can be followed by other hospitals in PNG and the Pacific. 10 The study on Bellwether access in our region was not based on estimated times from geo-spatial mapping 16 but rather by real journey times and only patients who reached hospital were included. However, our study did measure the real delays and identified that lack of transport has a major and real impact, regardless of distances by road or overseas.…”