J. S. Ng-Kamstra1,2,3, N. P. Raykar1,2,4, S. Mukhopadhyay1,2,5, R. R. Yorlets2, G. Anderson1,2,6, S. Saluja1,2,7, G. Toma1,2, A. Silverstein1,2,8, B. B. Massenburg1,2,9, E. Bruno1,2,10, H. E. Jenny1,2,9, I. H. Marks1,2,11, L. Ilcisin1,2,12, R. Sood1,2,8, S. Sharma1,2, J. G. Meara1,2, M. G. Shrime1,2,13 1Harvard Medical School,Department Of Global Health And Social Medicine,Boston, MA, USA 2Boston Children’s Hospital,Department Of Plastic And Oral Surgery,Boston, MA, USA 3University Of Toronto,Division Of General Surgery,Toronto, ON, Canada 4Beth Israel Deaconess Medical Center,Department Of Surgery,Boston, MA, USA 5University Of Connecticut Integrated Residency Programs,Department Of Surgery,Storrs, CT, USA 6Massachusetts General Hospital,Department Of Surgery,Boston, MA, USA 7Weill Cornell Medical College,Department Of Surgery,New York, NY, USA 8University Of Miami Miller School Of Medicine,Miami, FL, USA 9Icahn School Of Medicine At Mount Sinai,Department Of Medical Education,New York, NY, USA 10University Of Tennessee Health Science Center College Of Medicine,Memphis, TN, USA 11Barts And The London School Of Medicine And Dentistry,London, ENGLAND, United Kingdom 12Harvard Medical School,Department Of Medical Education,Boston, MA, USA 13Massachusetts Eye And Ear Infirmary,Department Of Otology And Laryngology And Office Of Global Surgery,Boston, MA, USA
Introduction:
Most of the world cannot access safe, affordable surgical and anesthesia care when needed. The global need for expanded access has been quantified, but surgical systems at a country level remain poorly described. The Lancet Commission on Global Surgery developed a set of six indicators that can point to opportunities to strengthen surgical systems, however, these are not yet uniformly collected. We aimed to collect country-level data on the proportion of the population within two hours of a surgical hospital (two-hour access), the number of surgical, anesthesia, and obstetric specialists per 100,000 population (SAO density), the number of surgical procedures per 100,000 population per year (surgical volume), the perioperative mortality rate (POMR), and the number of individuals who face impoverishing and catastrophic expenditures paying for surgery each year. Our goal is to collect robust data on at least 50% of countries for each indicator so that the World Bank can include these among the World Development Indicators.
Methods:
Collaborators contributed modelled estimates of surgical volume and SAO density, and a co-author provided modelled estimates of impoverishing and catastrophic expenditures. To collect primary data from Ministries of Health for the remaining indicators, we trained a team of eight research associates, developed an online data management system, assembled country contacts at Ministries of Health, and developed a strategy for outreach. With the support of our team, health leaders around the world reported data for their respective countries.
Results:
This work is ongoing, with anticipated completion in autumn 2015. To date, we have assembled modelled data on surgical volume, SAO density, and catastrophic and impoverishing expenditures for 194, 167, and 186 out of 215 countries, respectively. Two weeks after starting data collection, we have contacted 212 of 215 Ministries of Health. We have obtained at least partial data for 41 countries and have active communication with 44 more. Of these, 45 responses were from high-income countries (of 80 HIC total), 14 from upper-middle-income countries (of 53 UMIC), 14 from lower-middle-income countries (of 51 LMIC), and 12 from low-income countries (of 31 LIC).
Conclusion:
We have met WDI inclusion thresholds for four indicators using modelled data. New primary data will help to improve these estimates and to advance our understanding of the two remaining indicators: two-hour access and POMR. This effort will send a signal to the global health community that surgery is an "indivisible, indispensable part of health care" that requires investment and continual monitoring during the era of the Sustainable Development Goals.
