M. M. Esquivel1, J. A. Henry2, E. Frenkel3, C. Goddia4, T. Uribe-Leitz1, G. Rosenberg1, N. Garland1, T. G. Weiser1 4Queen Elizabeth Central Hospital,School Of Anaesthesia,Blantyre, BLANTYRE, Malawi 1Stanford University,General Surgery,Palo Alto, CA, USA 2University Of Chicago,General Surgery,Chicago, IL, USA 3Gradian Health Systems,New York, NEW YORK, USA
Introduction: Strong health systems require timely and safe surgical care to function, though many developing countries lack the human resources, supplies and infrastructure to provide this care. We completed a geospatial analysis to examine the surgical infrastructure and availability of essential surgery in Malawi and identified key priority areas for health system strengthening.
Methods: We identified all hospitals providing surgical care and collected on-site data using in-person interviews and surveys at each facility from November 5, 2012 to January 21, 2013. Surveys included information on location and type of facility, human resources, procedure availability, supplies and infrastructure. Data were geocoded and analyzed in Redivis, an online data visualization platform. We analyzed the catchment population that lived within a 2-hour travel time to these facilities, as recommended by the Lancet Commission on Global Surgery. We then evaluated the change in timely access when excluding facilities that lacked 24/7 access to three essential surgical procedures: emergency cesarean section, treatment of open fracture and laparotomy. We also analyzed the change in catchment population when excluding facilities that lacked consistent availability of eight minimum requirements for safe surgery: pulse oximetry, oxygen, adult bag mask, suction, intravenous fluids, sterile gloves, functioning sterilizer, and operating theater lights.
Results: We collected data from all 38 facilities that offered surgical care; 98.7% of the population (15,792,000 people) lived within 2-hours to these facilities. Even after excluding the 6 facilities that did not offer constant access to the three essential surgical procedures, there was no change in timely access. However, when we excluded facilities that did not have 24/7 access to the eight minimum requirements for safe surgery, only 34.0% (5,508,000 people) lived within 2-hours of a surgical facility meeting minimum safety standards.
Conclusion: The distribution of surgical facilities across Malawi is sufficient to cover the vast majority of the population, with most facilities offering the three essential procedures we evaluated. However, the basic infrastructure and supplies to provide safe surgery at these facilities is greatly lacking, and nearly 10.3 million people lose access when considering core requirements for safe surgery. This study highlights the need to strengthen surgical care and anesthesia in existing facilities. Geospatial techniques assist in identifying key facilities that would most greatly impact Malawi’s general population with improved resources for surgery.
