Y. Lin1,2, N. Raykar1, S. Saluja1, S. Mukhopadhyay1, S. Sharma1, B. Frett1, S. Enumah1, J. Meara1, M. Shrime1 1Harvard School Of Medicine,Program In Global Surgery And Social Change,Brookline, MA, USA 2University Of Colorado Denver,Department Of Surgery,Aurora, CO, USA
Introduction:
Over 5 billion people do not have access to timely, safe, and affordable surgical care, a cost-effective intervention with major public health impact. Fortunately, the overwhelming unmet surgical need has led to a rising interest in the scale-up of these services globally. Few tools exist, however, that provide comprehensive guidance to health systems planners on the infrastructure, workforce, service delivery, information management and financing elements necessary to build strong surgical systems. We aimed to critically review available guidelines and expert consensus to create an encompassing tool for local, national, regional and international surgical systems planning.
Methods:
PubMed and Google Scholar were searched to identify published documents cataloguing supply, equipment, and/or infrastructure elements for provision of surgical care. An expert panel was convened by The Lancet Commission on Global Surgery during its inaugural meeting in Boston in January 2014 which, among its other tasks, identified and obtained additional documents that were inaccessible through the published literature but part of the operating guidelines for global medical and surgical organizations. This panel consisted of clinicians, researchers, and public health experts from six countries of low-income, middle-income, and high-income country groupings. A comprehensive list of items was generated from these documents, and items with a reported frequency of >30% were included in the initial draft of the Hospital Assessment Tool. This tool was modified based on the Lancet Commission on Global Surgery’s (LCoGS) National Surgical Plan (NSP) framework. Adhering to Delphi methodology for survey validation, the updated tool was sent to providers working in low and middle income settings to create an expert-endorsed Hospital Assessment Tool.
Results:
Fifteen surgical tools were identified, containing a total of 216 unique elements related to surgical care delivery. Using the NSP framework, all elements were catalogued within infrastructure (n=152), service delivery (n=49), and workforce (n=15); no elements were identified within the domains of information management or financing. 18 individuals identified as expert providers participated in two rounds of Delphi validation. The final tool consisted of 160 items in the following domains: infrastructure (n=82), service delivery (n=35), workforce (n=21), information management (n=10), and financing (n=12).
Conclusion:
A careful, systematic approach to planning is critical to ensure successful scale-up of surgical services. Our analysis shows that existing guidance in this arena is varying in advice on the essential components of surgical care delivery. The Hospital Assessment Tool critically aggregates core elements across the five domains of surgical systems strengthening while allowing for adaptation to local context.