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Law TJ, Lipnick MS, Morriss W, Gelb AW, Mellin-Olsen J, Filipescu D, Rowles J, Rod P, Khan F, Yazbeck P, Zoumenou E, Ibarra P, Ranatunga K, Bulamba F. The Global Anesthesia Workforce Survey: Updates and Trends in the Anesthesia Workforce. Anesth Analg 2024; 139:15-24. [PMID: 38470828 DOI: 10.1213/ane.0000000000006836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
BACKGROUND There is a large global deficit of anesthesia providers. In 2016, the World Federation of Societies of Anaesthesiologists (WFSA) conducted a survey to count the number of anesthesia providers worldwide. Much work has taken place since then to strengthen the anesthesia health workforce. This study updates the global count of anesthesia providers. METHODS Between 2021 and 2023, an electronic survey was sent to national professional societies of physician anesthesia providers (PAPs), nurse anesthetists, and other nonphysician anesthesia providers (NPAPs). Data included number of providers and trainees, proportion of females, and limited intensive care unit (ICU) capacity data. Descriptive statistics were calculated by country, World Bank income group, and World Health Organization (WHO) region. Provider density is reported as the number of providers per 100,000 population. RESULTS Responses were obtained for 172 of 193 United Nations (UN) member countries. The global provider density was 8.8 (PAP 6.6 NPAP 2.3). Seventy-six countries had a PAP density <5, whereas 66 countries had a total provider density <5. PAP density increased everywhere except for high- and low-income countries and the African region. CONCLUSIONS The overall size of the global anesthesia workforce has increased over time, although some countries have experienced a decrease. Population growth and differences in which provider types that are counted can have an important impact on provider density. More work is needed to define appropriate metrics for measuring changes in density, to describe anesthesia cadres, and to improve workforce data collection processes. Effort to scale up anesthesia provider training must urgently continue.
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Affiliation(s)
- Tyler J Law
- From the Department of Anesthesia & Perioperative Care, University of California, San Francisco, California
- Center for Health Equity in Surgery and Anesthesia (CHESA), University of California, San Francisco, California
| | - Michael S Lipnick
- From the Department of Anesthesia & Perioperative Care, University of California, San Francisco, California
- Center for Health Equity in Surgery and Anesthesia (CHESA), University of California, San Francisco, California
| | - Wayne Morriss
- Department of Anaesthesia, University of Otago, Christchurch Hospital, Christchurch, New Zealand
- World Federation of Societies of Anaesthesiologists, London, United Kingdom
| | - Adrian W Gelb
- From the Department of Anesthesia & Perioperative Care, University of California, San Francisco, California
- Center for Health Equity in Surgery and Anesthesia (CHESA), University of California, San Francisco, California
- Department of Anesthesia, Intensive Care and Pain Management, Hôtel-Dieu University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Jannicke Mellin-Olsen
- World Federation of Societies of Anaesthesiologists, London, United Kingdom
- Department of Anaesthesia, Baerum Hospital, Oslo, Norway
| | - Daniela Filipescu
- World Federation of Societies of Anaesthesiologists, London, United Kingdom
- Department of Anaesthesiology & Intensive Care, Emergency Institute for Cardiovascular Disease, Bucharest, Romania
- Department of Anaesthesiology & Intensive Care, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Jackie Rowles
- School of Nurse Anesthesia, Texas Christian University, Fort Worth, Texas
- International Federation of Nurse Anesthetists, Mantes la Jolie, France
| | - Pascal Rod
- International Federation of Nurse Anesthetists, Mantes la Jolie, France
| | - Fauzia Khan
- World Federation of Societies of Anaesthesiologists, London, United Kingdom
- Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan
| | - Patrica Yazbeck
- World Federation of Societies of Anaesthesiologists, London, United Kingdom
- Department of Anesthesia, Intensive Care and Pain Management, Hôtel-Dieu University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Eugene Zoumenou
- Department of Anesthesiology, Centre National Hospitalier Universitaire de Cotonou, Cotonou, Benin
| | - Pedro Ibarra
- World Federation of Societies of Anaesthesiologists, London, United Kingdom
- Department of Anesthesiology, Clinica Reina Sofia, Bogota, Colombia
| | - Kumudini Ranatunga
- World Federation of Societies of Anaesthesiologists, London, United Kingdom
- Department of Cardiothoracic Anesthesia & Intensive Care, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Fred Bulamba
- Department of Anaesthesia, Faculty of Health Sciences, Busitema University, Mbale, Uganda
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Flocks Monaghan C, Pittalis C, Byrne E, Hussein I, Chilunjika T, Nandi B, Borgstein E, Gajewski J. The status of pediatric surgery in Malawi: a narrative mini-review. Front Pediatr 2023; 11:1195691. [PMID: 37484773 PMCID: PMC10357470 DOI: 10.3389/fped.2023.1195691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 06/22/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction Pediatric surgery is essential to a well-functioning health system. Unmet surgical needs contribute to 6.7% of pediatric deaths in Malawi. Understanding the current state of pediatric surgical care in Malawi is necessary to recognize gaps and opportunities in service delivery and to develop evidence-based national planning and solutions. Methods This narrative mini review synthesized the literature on the state of pediatric surgery in Malawi through the pillars of the World Health Organization's Health System Building Blocks. A search of PubMed, Embase, and Scopus databases was executed to identify relevant studies and a thematic analysis was performed. Further, to ensure contextual accuracy, pediatric surgeons from Malawi were consulted and involved in this review. Results Twenty-six papers were identified. In Malawi's central hospitals, there are six specialist pediatric surgeons for a pediatric population of more than 8 million. There is limited pediatric surgical capacity at the district hospitals. There is little to no written evidence of the national governing and finance structures in place for pediatric surgical services. Discussion In countries like Malawi, where a significant portion of the population comprises children, it is crucial to recognize that pediatric services are currently inadequate and fall short of the required standards. It is crucial to prioritize the enhancement of services specifically designed for this age group. This review aims to shed light on the existing gaps within pediatric surgical services in Malawi, providing valuable insights that can inform the development of comprehensive national surgical planning strategies.
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Affiliation(s)
- Celina Flocks Monaghan
- Institute of Global Surgery, School of Population Health, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Chiara Pittalis
- Institute of Global Surgery, School of Population Health, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Elaine Byrne
- Centre for Positive Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Israa Hussein
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Tiyamike Chilunjika
- Department of Surgery, University of Malawi College of Medicine, Zomba, Malawi
| | - Bip Nandi
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
- Michael E. Debakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Eric Borgstein
- Department of Surgery, University of Malawi College of Medicine, Zomba, Malawi
| | - Jakub Gajewski
- Institute of Global Surgery, School of Population Health, Royal College of Surgeons in Ireland, Dublin, Ireland
- Centre for Global Surgery, University of Stellenbosch, Cape Town, South Africa
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3
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Ravelojaona V, Ma X, Samison MF, Rabemalala D, Ayala R, Ramamonjisoa A, Andriamanjato HH, Ravoniaritsoa V, Jumbam DT, Andriamanarivo LM. Incorporating surgical and anesthesia care into universal health care: a national plan for the development of surgery in Madagascar. Can J Anaesth 2023; 70:1131-1154. [PMID: 37378826 DOI: 10.1007/s12630-023-02500-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 09/09/2022] [Accepted: 10/26/2022] [Indexed: 06/29/2023] Open
Abstract
Efforts have been made to strengthen national health systems for safe, affordable, and timely surgical, obstetric, trauma, and anesthesia (SOTA) care since 2015 when the Lancet Commission on Global Surgery (LCoGS) identified critical needs in improving access to essential surgical care for five billion people worldwide. Several governments have developed National Surgical, Obstetric, and Anesthesia Plans (NSOAPs) as a commitment to ensuring safe and accessible surgical care for all of their population. The Ministry of Public Health (MoPH) of Madagascar launched its NSOAP in May 2019, named Le Plan National de Développement de la Chirurgie a Madagascar (PNDCHM). This policy established Madagascar as the first African francophone country to define concrete objectives for the Malagasy health system to meet the targets set by the LCoGS by 2030. The PNDCHM outlined the following priorities and specific action points to be implemented from 2019 to 2023: improving technical capacity, training human resources, developing a health information system, ensuring adequate governance and leadership, offering quality care, creating specific surgical services, and financing and mobilizing resources for implementation. Challenges encountered in the process included complex coordination between different stakeholders, allocating a sufficient budget for its implementation, frequent turnover within the MoPH, and the COVID-19 pandemic. The PNDCHM is a first of its kind in francophone Africa and the many lessons learned can serve as guidance for countries aspiring to build NSOAPs of their own.
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Affiliation(s)
| | - Xiya Ma
- Division of Plastic Surgery, Université de Montréal, Montreal, QC, Canada
| | - Marie-Fidèle Samison
- Department of Standard of Care, Ministry of Public Health, Antananarivo, Madagascar
| | - Dominique Rabemalala
- Technical Direction of University Hospital of Befelatanana Maternity, Antananarivo, Madagascar
| | - Ruben Ayala
- Department of Policy and Advocacy, Operation Smile, Virginia Beach, VA, USA
| | - Anjaramamy Ramamonjisoa
- Department of Policy, Research and Innovation, Operation Smile Madagascar, Antananarivo, Madagascar
| | | | | | - Desmond T Jumbam
- Department of Policy and Advocacy, Operation Smile, Virginia Beach, VA, USA.
- Operation Smile Ghana, Accra, Greater Accra Region, Ghana.
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4
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Rose J, Law T. The Madagascar experience: a step forward in population-level evidence to guide national surgical obstetrics and anesthesia planning. Can J Anaesth 2023; 70:1117-1122. [PMID: 37428400 DOI: 10.1007/s12630-023-02497-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 02/04/2023] [Accepted: 02/09/2023] [Indexed: 07/11/2023] Open
Affiliation(s)
- John Rose
- Plastic and Reconstructive Surgery Clinic, University of California San Francisco, San Francisco, CA, USA.
- Center for Health Equity in Surgery and Anesthesia, University of California San Francisco, San Francisco, CA, USA.
- Phillip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA.
- Plastic and Reconstructive Surgery, UCSF Medical Center, 505 Parnassus Ave., M-593 Box 0932, San Francisco, CA, 94143, USA.
| | - Tyler Law
- Center for Health Equity in Surgery and Anesthesia, University of California San Francisco, San Francisco, CA, USA
- Department of Anesthesia & Perioperative Care, University of California San Francisco, San Francisco, CA, USA
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
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5
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Jumbam DT, Reddy CL, Meara JG, Makasa EM, Atun R. A Financing Strategy to Expand Surgical Health Care. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2100295. [PMID: 37348937 PMCID: PMC10285720 DOI: 10.9745/ghsp-d-21-00295] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 03/28/2023] [Indexed: 06/24/2023]
Abstract
Despite an evolving need to provide surgical health care globally, few health systems, particularly in low-income and middle-income countries (LMICs), can sufficiently provide such care. The vast majority of the world's people-an estimated 5 billion-are unable to access safe and affordable surgical health care when they need it. This is a significant concern for global public health because the demand for these services is rising with the epidemiological and demographic transitions occurring worldwide. A principal driver of weak surgical health care services is a lack of adequate health system financing for surgical health care. This article examines the financing of surgical health care by analyzing global trends in health system financing, approaches to expand fiscal space for health, and empirical perspectives on the design, introduction, and scale-up of policies to improve surgical systems. We describe a surgical health care financing strategy, together with broader political and economic considerations, to provide policy recommendations to fund the expansion of surgical health care and an essential surgical package as part of universal health coverage in LMICs.
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Affiliation(s)
- Desmond T Jumbam
- Department of Policy and Advocacy, Operation Smile, Virginia Beach, VA, USA
| | - Che L Reddy
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
- Health Systems Innovation Lab, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Emmanuel M Makasa
- Wits Centre of Surgical Care for Primary Health and Sustainable Development, School of Clinical Medicine, University of Witwatersrand, Johannesburg, South Africa
| | - Rifat Atun
- Health Systems Innovation Lab, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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6
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Jumbam DT, Bustamante A, Alayande BT, Ayala R, Kouam JC, Dzirasa I, Segura C, Kum FV, Muhumuza A, Riviello R, Rata M, Foretia DA, Bekele A. To advance global surgery and anaesthesia, train more advocates. BMJ Glob Health 2023; 8:bmjgh-2023-012848. [PMID: 37270175 DOI: 10.1136/bmjgh-2023-012848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 05/22/2023] [Indexed: 06/05/2023] Open
Affiliation(s)
- Desmond T Jumbam
- Department of Health Policy and Advocacy, Operation Smile, Virginia Beach, Virginia, USA
| | - Atenas Bustamante
- Department of Health Policy and Advocacy, Operation Smile, Virginia Beach, Virginia, USA
| | | | - Ruben Ayala
- Department of Health Policy and Advocacy, Operation Smile, Virginia Beach, Virginia, USA
| | - Jean Cedric Kouam
- Nkafu Policy Institute, Denis & Lenora Foretia Foundation, Yaounde, Cameroon
| | - Irene Dzirasa
- Department of Health Policy and Advocacy, Operation Smile, Virginia Beach, Virginia, USA
- Operation Smile Ghana, Accra, Ghana
| | - Carolina Segura
- Department of Health Policy and Advocacy, Operation Smile, Virginia Beach, Virginia, USA
| | - Fuein Vera Kum
- Nkafu Policy Institute, Denis & Lenora Foretia Foundation, Yaounde, Cameroon
| | - Arsen Muhumuza
- Department of Health Policy and Advocacy, Operation Smile, Virginia Beach, Virginia, USA
| | - Robert Riviello
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Mikyla Rata
- Department of Health Policy and Advocacy, Operation Smile, Virginia Beach, Virginia, USA
| | - Denis A Foretia
- Nkafu Policy Institute, Denis & Lenora Foretia Foundation, Yaounde, Cameroon
- Global Surgery Institute, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Abebe Bekele
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
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Zaigham M, Bryce-Alberti M, Calderon C, Campos LN, Raguveer V, Nuss S, Dutta R, Naus AE, Forbes C, Park KB, McClain CD. The time to act is now: a call to action on planetary health and sustainable surgical systems. Lancet Planet Health 2022; 6:e931-e932. [PMID: 36370731 DOI: 10.1016/s2542-5196(22)00261-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Mehreen Zaigham
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; Obstetrics and Gynecology Institution of Clinical Sciences Lund, Lund University, Lund, Sweden.
| | - Mayte Bryce-Alberti
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Chrystal Calderon
- Faculty of Medical Sciences, University of the West Indies, St Augustine, Trinidad and Tobago
| | - Letícia Nunes Campos
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; Faculty of Medical Sciences, Universidade de Pernambuco, Recife, Brazil
| | - Vanitha Raguveer
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; University of Illinois College of Medicine, Chicago, IL, USA
| | - Sarah Nuss
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Rohini Dutta
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; Mary Horigan Connor's Centre for Gender and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA
| | - Abbie E Naus
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Callum Forbes
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; University of Global Health Equity, Kigali, Rwanda
| | - Kee B Park
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA
| | - Craig D McClain
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
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8
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Samper AFG, Herrera-Almario GE, Tulloch D, Blanco D, Cardoso LL, Rocha REN, Rajan R, Gracias V, Hanna JS. A granular analysis of service delivery for surgical system strengthening: Application of the Lancet indicators for policy development in Colombia. LANCET REGIONAL HEALTH. AMERICAS 2022; 10:100217. [PMID: 36777688 PMCID: PMC9904114 DOI: 10.1016/j.lana.2022.100217] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND The Lancet Commission on Global Surgery (LCoGS) surgical indicators have given the surgical community metrics for objectively characterizing the disparity in access to surgical healthcare. However, aggregate national statistics lack sufficient specificity to inform strengthening plans at the community level. We performed a second-stage analysis of Colombian surgical system service delivery to inform the development of resource- and context-sensitive interventions to inform a revision of the Decennial Public Health Plan for access inequity resolution. METHODS Data from the year 2016 to inform total operative volume (TOV) and 30-day non-risk adjusted peri-operative mortality (POMR) were collected from the Colombian national health information system. TOV and POMR were sub-characterized by demographics, urgency, service line, disease pathology and facility location. FINDINGS In 2016, aggregate national mortality was 0·87%, while mortality attributable to elective and emergency surgery was 0·73% and 1·30%, respectively. The elderly experienced a 5·6-fold higher mortality, with 4·2% undergoing an operation within 30 days of dying. Individuals undergoing hepatobiliary, thoracic, cardiac, and neurosurgical operations experienced the highest mortality rates while obstetrics, general surgery, orthopaedics, and urology performed the largest procedure volume. Finally, analysis of operation and service line specific POMR reveals opportunities for improvement. INTERPRETATION This granular second-stage analysis provides actionable data which is fundamental to the development of resource and context-sensitive interventions to address gaps and inequities in surgical system service delivery. Furthermore, this analysis validates the modeling underlying development of the LCoGS indicators. These data will inform the assessment of implementation priorities and revision of the Colombian Decennial Public Health Plan. FUNDING None.
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Affiliation(s)
| | - Gabriel E. Herrera-Almario
- School of Medicine, Universidad de Los Andes, Bogotá, Colombia
- Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - David Tulloch
- Center for Remote Sensing and Spatial Analysis, Rutgers School of Environmental and Biological Sciences, New Brunswick, NJ, USA
| | - Daniela Blanco
- School of Medicine, Universidad de Los Andes, Bogotá, Colombia
| | | | | | - Roshni Rajan
- Rutgers Robert Wood Johnson Medical School, 125 Paterson St., Suite 6300, New Brunswick, NJ 08903, USA
| | - Vicente Gracias
- Rutgers Robert Wood Johnson Medical School, 125 Paterson St., Suite 6300, New Brunswick, NJ 08903, USA
- Rutgers Global Health Institute, New Brunswick, NJ, USA
| | - Joseph S. Hanna
- Rutgers Robert Wood Johnson Medical School, 125 Paterson St., Suite 6300, New Brunswick, NJ 08903, USA
- Rutgers Global Health Institute, New Brunswick, NJ, USA
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9
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Law TJ, Rose J, Gelb AW. Initiatives to support rural access to anesthesia. Can J Anaesth 2022; 69:790-791. [PMID: 35301698 DOI: 10.1007/s12630-022-02242-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 01/20/2022] [Accepted: 01/20/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Tyler J Law
- Center for Health Equity in Surgery & Anesthesia, University of California, San Francisco, CA, USA.
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA.
| | - John Rose
- Center for Health Equity in Surgery & Anesthesia, University of California, San Francisco, CA, USA
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco, CA, USA
| | - Adrian W Gelb
- Center for Health Equity in Surgery & Anesthesia, University of California, San Francisco, CA, USA
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA
- World Federation of Societies of Anaesthesiologists, London, United Kingdom
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10
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Olivieri DJ, Thapa R, Greenberg PB. Increasing local engagement in global eye care policy. Graefes Arch Clin Exp Ophthalmol 2021; 259:2455-2456. [PMID: 33464379 DOI: 10.1007/s00417-021-05080-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 12/28/2020] [Accepted: 01/09/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Daniel J Olivieri
- Division of Ophthalmology, Brown University, Coro Center West, Suite 200, 1 Hoppin Street, Providence, RI, USA.,Watson Institute for International and Public Affairs, Brown University, Providence, RI, USA.,Section of Ophthalmology, Providence Veterans Affairs Medical Center, Providence, RI, USA
| | - Raba Thapa
- Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Paul B Greenberg
- Division of Ophthalmology, Brown University, Coro Center West, Suite 200, 1 Hoppin Street, Providence, RI, USA. .,Section of Ophthalmology, Providence Veterans Affairs Medical Center, Providence, RI, USA.
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11
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Reddy CL, Vervoort D, Meara JG, Atun R. Surgery and universal health coverage: Designing an essential package for surgical care expansion and scale-up. J Glob Health 2020; 10:020341. [PMID: 33110540 PMCID: PMC7562729 DOI: 10.7189/jogh.10.02034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ché L Reddy
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Dominique Vervoort
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Rifat Atun
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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12
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Reddy CL, Vervoort D, Meara JG, Atun R. Surgery and universal health coverage: Designing an essential package for surgical care expansion and scale-up. J Glob Health 2020. [PMID: 33110540 PMCID: PMC7562729 DOI: 10.7189/jogh.10.020349] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Ché L Reddy
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Dominique Vervoort
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Rifat Atun
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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13
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Roa L, Velin L, Tudravu J, McClain CD, Bernstein A, Meara JG. Climate change: challenges and opportunities to scale up surgical, obstetric, and anaesthesia care globally. Lancet Planet Health 2020; 4:e538-e543. [PMID: 33159881 DOI: 10.1016/s2542-5196(20)30247-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/16/2020] [Accepted: 09/24/2020] [Indexed: 06/11/2023]
Abstract
Climate change affects human health in a myriad of ways, requiring reassessment of the nature of scaling up care delivery and the effect that care delivery has on the environment. 5 billion people do not have access to safe and timely surgical care, and the quantity and severity of conditions that require surgical, obstetric, and anaesthesia care will increase substantially as a result of climate change. However, surgery is resource intensive and contributes substantially to greenhouse-gas emissions. In response to climate change, the surgical, obstetric, and anaesthesia community has a key role to play to ensure that a scale-up of service delivery incorporates mitigation and adaptation strategies. As countries scale up surgical care, understanding the implications of surgery on climate change and the implications of climate change on surgical care will be crucial in the development of health policies.
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Affiliation(s)
- Lina Roa
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA; Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB, Canada.
| | - Lotta Velin
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA; Surgery and Public Health, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | | | - Craig D McClain
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA; Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Aaron Bernstein
- Center for Climate, Health and the Global Environment, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA; Climate and Health Initiative, Harvard Global Health Institute, Harvard University, Cambridge, MA, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
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Hanna JS, Herrera-Almario GE, Pinilla-Roncancio M, Tulloch D, Valencia SA, Sabatino ME, Hamilton C, Rehman SU, Mendoza AK, Gómez Bernal LC, Salas MFM, Navarro MAP, Nemoyer R, Scott M, Pardo-Bayona M, Rubiano AM, Ramirez MV, Londoño D, Dario-Gonzalez I, Gracias V, Peck GL. Use of the six core surgical indicators from the Lancet Commission on Global Surgery in Colombia: a situational analysis. LANCET GLOBAL HEALTH 2020; 8:e699-e710. [PMID: 32353317 DOI: 10.1016/s2214-109x(20)30090-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Surgical, anaesthetic, and obstetric (SAO) health-care system strengthening is needed to address the emergency and essential surgical care that approximately 5 billion individuals lack globally. To our knowledge, a complete, non-modelled national situational analysis based on the Lancet Commission on Global Surgery surgical indicators has not been done. We aimed to undertake a complete situation analysis of SAO system preparedness, service delivery, and financial risk protection using the core surgical indicators proposed by the Commission in Colombia, an upper-middle-income country. METHODS Data to inform the six core surgical system indicators were abstracted from the Colombian national health information system and the most recent national health survey done in 2007. Geographical access to a Bellwether hospital (defined as a hospital capable of providing essential and emergency surgery) within 2 h was assessed by determining 2 h drive time boundaries around Bellwether facilities and the population within and outside these boundaries. Physical 2 h access to a Bellwether was determined by the presence of a motor vehicle suitable for individual transportation. The Department Administrativo Nacional de Estadística population projection for 2016 and 2018 was used to calculate the SAO provider density. Total operative volume was calculated for 2016 and expressed nationally per 100 000 population. The total number of postoperative deaths that occurred within 30 days of a procedure was divided by the total operative volume to calculate the all-cause, non-risk-adjusted postoperative mortality. The proportion of the population subject to impoverishing costs was calculated by subtracting the baseline number of impoverished individuals from those who fell below the poverty line once out-of-pocket payments were accounted for. Individuals who incurred out-of-pocket payments that were more than 10% of their annual household income were considered to have experienced catastrophic expenditure. Using GIS mapping, SAO system preparedness, service delivery, and cost protection were also contextualised by socioeconomic status. FINDINGS In 2016, at least 7·1 million people (15·1% of the population) in Colombia did not have geographical access to SAO services within a 2 h driving distance. SAO provider density falls short of the Commission's minimum target of 20 providers per 100 000 population, at an estimated density of 13·7 essential SAO health-care providers per 100 000 population in 2018. Lower socioeconomic status of a municipality, as indicated by proportion of people enrolled in the subsidised insurance regime, was associated with a smaller proportion of the population in the municipality being within 2 h of a Bellwether facility, and the most socioeconomically disadvantaged municipalities often had no SAO providers. Furthermore, Colombian providers appear to be working at or beyond capacity, doing 2690-3090 procedures per 100 000 population annually, but they have maintained a relatively low median postoperative mortality of 0·74% (IQR 0·48-0·84). Finally, out-of-pocket expenses for indirect health-care costs were a key barrier to accessing surgical care, prompting 3·1 million (6·4% of the population) individuals to become impoverished and 9·5 million (19·4% of the population) individuals to incur catastrophic expenditures in 2007. INTERPRETATION We did a non-modelled, indicator-based situation analysis of the Colombian SAO system, finding that it has not yet met, but is working towards achieving, the targets set by the Lancet Commission on Global Surgery. The observed interdependence of these indicators and correlation with socioeconomic status are consistent with well recognised factors and outcomes of social, health, and health-care inequity. The internal consistency observed in Colombia's situation analysis validates the use of the indicators and has now informed development of an early national SAO plan in Colombia, to set a data-informed stage for implementation and evaluation of timely, safe, and affordable SAO health care, within the National Public Health Decennial Plan, which is due in 2022. FUNDING Zoll Medical.
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Affiliation(s)
- Joseph S Hanna
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA.
| | - Gabriel E Herrera-Almario
- Fundación Santa Fe de Bogotá, Bogotá, Colombia; School of Medicine, Universidad de los Andes, Bogotá, Colombia
| | | | - David Tulloch
- Center for Remote Sensing and Spatial Analysis, Rutgers School of Environmental and Biological Sciences, The State University of New Jersey, New Brunswick, NJ, USA
| | | | - Marlena E Sabatino
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Charles Hamilton
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Shahyan U Rehman
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Ardi Knobel Mendoza
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | | | | | | | - Rachel Nemoyer
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Michael Scott
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | | | - Andres M Rubiano
- School of Medicine and Neuroscience Institute, Universidad el Bosque, Bogotá, Colombia
| | | | | | | | - Vicente Gracias
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA; Rutgers New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Gregory L Peck
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA; Rutgers School of Public Health, Rutgers Biomedical and Health Sciences, Piscataway, NJ, USA
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Reddy CL, Peters AW, Jumbam DT, Caddell L, Alkire BC, Meara JG, Atun R. Innovative financing to fund surgical systems and expand surgical care in low-income and middle-income countries. BMJ Glob Health 2020; 5:e002375. [PMID: 32546586 PMCID: PMC7299051 DOI: 10.1136/bmjgh-2020-002375] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 02/02/2023] Open
Abstract
Strong surgical systems are necessary to prevent premature death and avoidable disability from surgical conditions. The epidemiological transition, which has led to a rising burden of non-communicable diseases and injuries worldwide, will increase the demand for surgical assessment and care as a definitive healthcare intervention. Yet, 5 billion people lack access to timely, affordable and safe surgical and anaesthesia care, with the unmet demand affecting predominantly low-income and middle-income countries (LMICs). Rapid surgical care scale-up is required in LMICs to strengthen health system capabilities, but adequate financing for this expansion is lacking. This article explores the critical role of innovative financing in scaling up surgical care in LMICs. We locate surgical system financing by using a modified fiscal space analysis. Through an analysis of published studies and case studies on recent trends in the financing of global health systems, we provide a conceptual framework that could assist policy-makers in health systems to develop innovative financing strategies to mobilise additional investments for scale-up of surgical care in LMICs. This is the first time such an analysis has been applied to the funding of surgical care. Innovative financing in global surgery is an untapped potential funding source for expanding fiscal space for health systems and financing scale-up of surgical care in LMICs.
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Affiliation(s)
- Ché L Reddy
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Alexander W Peters
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Desmond Tanko Jumbam
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Luke Caddell
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Blake C Alkire
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Center for Global Surgery Evaluation, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Department of Global Health Equity, Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Rifat Atun
- Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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16
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Fatima I, Shoman H, Peters AW, Samad L, Nishtar S. Pakistan's National Surgical, Obstetric, and Anesthesia Plan: an adapted model for a devolved federal-provincial health system. Can J Anaesth 2020; 67:1212-1216. [PMID: 32409943 DOI: 10.1007/s12630-020-01708-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/10/2020] [Accepted: 04/10/2020] [Indexed: 10/24/2022] Open
Affiliation(s)
- Irum Fatima
- Global Health Directorate, Indus Health Network, Karachi, Pakistan.
| | - Haitham Shoman
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Alexander W Peters
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.,Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Lubna Samad
- Global Health Directorate, Indus Health Network, Karachi, Pakistan
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17
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Exploring the knowledge and attitudes of Cameroonian medical students towards global surgery: A web-based survey. PLoS One 2020; 15:e0232320. [PMID: 32353038 PMCID: PMC7192476 DOI: 10.1371/journal.pone.0232320] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/12/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction Global surgery is a growing field studying the determinants of safe and affordable surgical care and advocating to gain the global health community's attention. In Cameroon, little is known about the level of knowledge and attitudes of students. Our survey aimed to describe the knowledge and attitudes of Cameroonian medical students towards global surgery. Materials and methods We performed an anonymous online survey of final-year Cameroonian medical students. Mann-Whitney U test and Spearman correlation analysis were used for bivariate analysis, and the alpha value was set at 0.05. Odds ratios and their 95% confidence intervals were calculated. Results 204 respondents with a mean age of 24.7 years (±2.0) participated in this study. 58.3% were male, 41.6% had previously heard or read about global surgery, 36.3% had taken part in a global surgery study, and 10.8% had attended a global surgery event. Mercy Ships was well known (46.5%), and most students believed that surgical interventions were more costly than medical treatments (75.0%). The mean score of the global surgery evaluation was 47.4% (±29.6%), and being able to recognize more global surgery organizations was correlated with having assumed multiple roles during global surgery studies (p = 0.008) and identifying more global surgery indicators (p = 0.04). Workforce, infrastructure, and funding were highlighted as the top priorities for the development of global surgery in Cameroon. Conclusion Medical students are conscious of the importance of surgical care. They lack the opportunities to nurture their interest and should be taught global surgery concepts and skills.
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Kasole-Zulu T, Ndebea AS, Chikumbanje SS, Bould MD. Anesthesia Capacity in Rural Zambia, Malawi, and Tanzania: The Anesthesiologist's Perspective. Anesth Analg 2020; 130:841-844. [PMID: 32175999 DOI: 10.1213/ane.0000000000004638] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Tuma Kasole-Zulu
- From the Department of Anaesthesia and Critical Care, Mansa General Hospital, Mansa, Zambia
| | - Ansbert S Ndebea
- Department of Anaesthesia, Kilimanjaro Christian Medical University College, Kilimanjaro, Moshi, Tanzania
| | - Singatiya S Chikumbanje
- Department of Anaesthesia and Intensive Care, Queen Elizabeth Central Hospital, University of Malawi College of Medicine, Blantyre, Malawi
| | - M Dylan Bould
- Department of Anesthesiology and Pain Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
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19
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In reply: Clarifying surgery and anesthesia partnerships in response to global surgery and the World Health Organization. Can J Anaesth 2019; 67:148-149. [PMID: 31556007 DOI: 10.1007/s12630-019-01485-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 09/03/2019] [Accepted: 09/03/2019] [Indexed: 10/25/2022] Open
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