ACCESS TO SURGICAL CARE

ACCESS TO SURGICAL CARE

The Lancet Commission on Global Surgery (2015) estimated that 5 billion out of the 7 billion people on the planet do not have access to surgery (see Summary box 16.2 ). This is concerning, as access to timely life-saving essential surgery is a fundamental need for all. Although barriers to surgical access appear to be pronounced in LMICs, there are also disadvantaged and vulnerable populations in HICs. Access to ∩ ∩ ∩ surgery can be viewed through four lenses, namely; timeliness, capacity , safety and a ff ordability ( Figure 16.1 ). Geographical access is the ability of a patient to reach a surgical facility within 2 hours, which is the crucial time for life- threatening haemorrhage. Capacity denotes that the facility has the required infrastructure and workf orce and is able to perform safe surgery . However, the final barrier is when a patient cannot a ff ord the surgery o ff ered. A staggering nine out of 10 people in LMICs do not have access to surgery . Consequently , patients with acute surgical needs in LMICs do not reach hospital or reach it too late, in advanced stages of cancer, with already infected open fractures, with a perforated bowel or with burn contractures. The world needs 143 million more surgical operations (unmet need) to be performed each year to save lives and prevent disability . Of the 313 million procedures undertaken world wide each year, only 6% occur in the poorest countries, where over one-third of the world’s population lives (see Further reading ). Unmet need is greatest in eastern, western and central sub-Saharan Africa and South Asia. These regions have young mothers dying of physiological conditions such as pregnancy , for want of a caesarean section. The global surgical community hopes to achieve an optimum operative volume of 5000 surgical procedures per 100 /uni00A0 000 population across the world by 2030. Currently , there are countries such as Ethiopia which do 150 operations per 100 /uni00A0 000 population, while Hungary performs 23 /uni00A0 000. However, more than 5000 operations and further expenditure do not bring commensurate health benefits to the population. Low operative volumes are also associated with high case-fatality rates from common, treatable surgical conditions, which include injuries, early cancer and burns.

No No No access No access p (access) = p ( T C S A ) Probability of access is the joint probability of timely care, surgical capacity, safe surgery and affordability Figure 16.1 Access to surgery: the four dimensions.

ACCESS TO SURGICAL CARE

The Lancet Commission on Global Surgery (2015) estimated that 5 billion out of the 7 billion people on the planet do not have access to surgery (see Summary box 16.2 ). This is concerning, as access to timely life-saving essential surgery is a fundamental need for all. Although barriers to surgical access appear to be pronounced in LMICs, there are also disadvantaged and vulnerable populations in HICs. Access to ∩ ∩ ∩ surgery can be viewed through four lenses, namely; timeliness, capacity , safety and a ff ordability ( Figure 16.1 ). Geographical access is the ability of a patient to reach a surgical facility within 2 hours, which is the crucial time for life- threatening haemorrhage. Capacity denotes that the facility has the required infrastructure and workf orce and is able to perform safe surgery . However, the final barrier is when a patient cannot a ff ord the surgery o ff ered. A staggering nine out of 10 people in LMICs do not have access to surgery . Consequently , patients with acute surgical needs in LMICs do not reach hospital or reach it too late, in advanced stages of cancer, with already infected open fractures, with a perforated bowel or with burn contractures. The world needs 143 million more surgical operations (unmet need) to be performed each year to save lives and prevent disability . Of the 313 million procedures undertaken world wide each year, only 6% occur in the poorest countries, where over one-third of the world’s population lives (see Further reading ). Unmet need is greatest in eastern, western and central sub-Saharan Africa and South Asia. These regions have young mothers dying of physiological conditions such as pregnancy , for want of a caesarean section. The global surgical community hopes to achieve an optimum operative volume of 5000 surgical procedures per 100 /uni00A0 000 population across the world by 2030. Currently , there are countries such as Ethiopia which do 150 operations per 100 /uni00A0 000 population, while Hungary performs 23 /uni00A0 000. However, more than 5000 operations and further expenditure do not bring commensurate health benefits to the population. Low operative volumes are also associated with high case-fatality rates from common, treatable surgical conditions, which include injuries, early cancer and burns.

No No No access No access p (access) = p ( T C S A ) Probability of access is the joint probability of timely care, surgical capacity, safe surgery and affordability Figure 16.1 Access to surgery: the four dimensions.

ACCESS TO SURGICAL CARE

The Lancet Commission on Global Surgery (2015) estimated that 5 billion out of the 7 billion people on the planet do not have access to surgery (see Summary box 16.2 ). This is concerning, as access to timely life-saving essential surgery is a fundamental need for all. Although barriers to surgical access appear to be pronounced in LMICs, there are also disadvantaged and vulnerable populations in HICs. Access to ∩ ∩ ∩ surgery can be viewed through four lenses, namely; timeliness, capacity , safety and a ff ordability ( Figure 16.1 ). Geographical access is the ability of a patient to reach a surgical facility within 2 hours, which is the crucial time for life- threatening haemorrhage. Capacity denotes that the facility has the required infrastructure and workf orce and is able to perform safe surgery . However, the final barrier is when a patient cannot a ff ord the surgery o ff ered. A staggering nine out of 10 people in LMICs do not have access to surgery . Consequently , patients with acute surgical needs in LMICs do not reach hospital or reach it too late, in advanced stages of cancer, with already infected open fractures, with a perforated bowel or with burn contractures. The world needs 143 million more surgical operations (unmet need) to be performed each year to save lives and prevent disability . Of the 313 million procedures undertaken world wide each year, only 6% occur in the poorest countries, where over one-third of the world’s population lives (see Further reading ). Unmet need is greatest in eastern, western and central sub-Saharan Africa and South Asia. These regions have young mothers dying of physiological conditions such as pregnancy , for want of a caesarean section. The global surgical community hopes to achieve an optimum operative volume of 5000 surgical procedures per 100 /uni00A0 000 population across the world by 2030. Currently , there are countries such as Ethiopia which do 150 operations per 100 /uni00A0 000 population, while Hungary performs 23 /uni00A0 000. However, more than 5000 operations and further expenditure do not bring commensurate health benefits to the population. Low operative volumes are also associated with high case-fatality rates from common, treatable surgical conditions, which include injuries, early cancer and burns.

No No No access No access p (access) = p ( T C S A ) Probability of access is the joint probability of timely care, surgical capacity, safe surgery and affordability Figure 16.1 Access to surgery: the four dimensions.