F. Carrillo1,2, Z. Fowler3, S. Mohar1, E. Moeller3, L. Roa3,4, R. Koch3,5, T. Sanchez1, S. Cervantes1, L. Cadelle3, V. Macías1, R. Riviello3,8, J. G. Meara3, A. Cervantes-Trejo6, I. Mathews7, T. Uribe-Leitz8 1Compañeros En Salud,Departamento De Cirugía,Ángel Albino Corzo, CHIAPAS, Mexico 2Instituto Tecnológico Y De Estudios Superiores De Monterrey,Escuela De Medicina Y Ciencias De La Salud,Guadalajara, JALISCO, Mexico 3Harvard Medical School,Program In Global Surgery And Social Change,Boston, MA, USA 4University Of Alberta,Department Of Obstetrics & Gynecology,Alberta, EDMONTON, Canada 5Vanderbilt University Medical Center,Department Of Surgery,Nashville, TN, USA 6Universidad Anáhuac,Facultad De Ciencias De La Salud,Huixquilucan, ESTADO DE MÉXICO, Mexico 7Redivis,Mountain View, CA, USA 8Brigham And Women’s Hospital,Center For Surgery And Public Health, Department Of Surgery,Boston, MA, USA
Introduction: The Lancet Commission on Global Surgery (LCoGS) advocates for universal access to safe, affordable, and timely surgical and anesthesia care and proposed six surgical indicators to assess surgical systems, including geographic access to a surgical facility. We sought to determine 2-hour access to surgical facilities capable of performing the Bellwether procedures (laparotomy, cesarean delivery and open fractures) in Chiapas, Mexico, the poorest state. This is the first study in Mexico to provide a complete assessment of surgical facilities including both private and public.
Methods: We identified public sector facilities from the Mexican Ministry of Health (MoH) public access hospital discharge database, through a multidimensional On-Line Analytical Processing software. Private sector facilities were obtained from Mexico´s Digital Statistical Directory of Economic Units, which compiles geographic locationsof all economic establishments in the county including geocoordinates for all health care facilities. We defined surgical facilities as those that had a functional operating room and performed the Bellwether procedures using ICD-9 CPT codes, this information was confirmed through the hospitals official website or via telephone. We assessed population acceess within 2-hour travel time to essential surgical facilities in Redivis (Redivis Inc), road infrastructure from OpenStreetMap and population data from WorldPop.
Results: We identified 97 facilities with surgical capacity in Chiapas, from which 32 perform all three Bellwether procedures, 5 in the private sector and 27 in the public sector (6 from Mexican Social Security Institute (IMSS), and 21 from the System for Social Health Protection (SPPS)). 82.1% (n=5, 217,908 people) of the population lives within 2-hours of a surgical facility capable of performing Bellwether procedures. Coverage extended to neighboring states with 0.5% coverage for Oaxaca and 6.2% coverage for Tabasco. Further analysis of Mexico’s public health system showed that 34% of the population is covered by IMSS and 79.3% of the population is covered by SPPS. Private hospitals cover 65.9% of the population. Close to half of the population (48.5%) lives within 2-hour access to secondary and tertiary care facilities that perform the three Bellwether procedures.
Conclusion: Geographic access to surgical care in Chiapas is met according to the LCoGS indicator, with more than 80% of the population covered. However, this is likely an overestimate as each coverage scheme (public-IMSS, SPPS, private) poses additional barriers to access. Our results can guide stakeholders allocate limited resources and inform public policy to ensure timely, affordable access to lifesaving essential surgical care for all.
