M. Esquivel1, T. Uribe-Leitz1, I. Mathews6, N. Raykar2,3, E. Makasa4, K. Bowman5, T. Weiser1 1Stanford University School Of Medicine,General Surgery,Stanford, CA, USA 2Harvard Medical School,Program In Global Surgery And Social Change,Boston, MA, USA 3Beth Isreal Deaconess Medical Center,Department Of Surgery,Boston, MA, USA 4Permanent Mission Of Zambia,Health,Geneva, GE, Switzerland 5Children’s Hospital Of Wisconsin,Division Of Pediatric General And Thoracic Surgery,Milwaukee, WI, USA 6Redivis, Inc,Mountain View, CA, USA
Introduction: Surgical health advocates recommend that countries evaluate and report on surgical services in order to understand and improve availability of surgical care. Health planners and ministries of health would benefit from this type of data to inform key decisions. We used a data visualization tool to analyze surgical infrastructure, capacity, and availability of surgical care in Zambia.
Methods: All hospitals providing surgical care in 2010 were identified in cooperation with the Zambian Ministry of Health. On-site data collection included location and type of hospital, procedure availability, human resources, and infrastructure using an adapted WHO Global Initiative for Emergency and Essential Surgical Care survey from October 2010 through August 2011. Data were geocoded using ArcGIS 10.3 and analyzed in Redivis, an online visualization platform. We analyzed time and distance to surgical services, as well as the proportion of the population covered within a two-hour travel time, as recommended by the Lancet Commission on Global Surgery.
Results: Data were collected from all 103 surgical facilities identified as providing surgical care using direct observations and 495 interviews with providers at the facilities. When including all surgical facilities (regardless of human resources and supplies), 8% of the population (1.16 million people) lived more than a 2-hour drive from surgical care (Figure 1a). When the World Health Organization criteria for minimal safety standards (the minimal complement of equipment and supplies to maintain an airway, resuscitation and sterility for surgical care) were included in the analysis, access declined; only 17 (16.5%) hospitals met the minimum standards of surgical safety, defined as the availability of a pulse oximeter, adult bag mask, oxygen, suction, intravenous fluid, sterile gloves, skin preparation solution, and a functioning sterilizer. Geospatial analysis of these 17 hospitals showed that 58% of the population (8.41 million people) lived more than a 2-hour drive from a facility with a minimal complement of infrastructure for surgical care (Figure 1b).
Conclusion: A large proportion of the population in Zambia does not have access to safe and timely surgical care. Our study highlights that overall Zambia has sufficient surgical centers spread out across the country. However, human resources, infrastructure, and supplies within these facilities are limited and must be addressed to improve access to safe surgical care. The use of geospatial visualization tools assists in the evaluation of surgical infrastructure in Zambia, and can identify key areas for improvement. This type of geospatial analysis could help with health system planning across many countries and health services.
