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Abiiro GA. Regaining policy attention for a health insurance capitation payment reform in Ghana: A prospective policy analysis. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003265. [PMID: 38814906 PMCID: PMC11139315 DOI: 10.1371/journal.pgph.0003265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/01/2024] [Indexed: 06/01/2024]
Abstract
Capitation as a provider payment mechanism gained policy attention by the Ghana National Health Insurance Scheme (NHIS) in 2012 and was piloted in the Ashanti Region, Ghana. Recent studies revealed that the policy was suspended in 2017 due to inappropriate policy framing, actor contestations, unclear policy design characteristics, and an unfavorable political context. However, the NHIS still has interest in capitation as a provider payment option. Using the modified political process model, a prospective policy analysis was conducted to explore how to: i) appropriately reframe policy debates; ii) create political opportunities; and iii) mobilize resources to reattract policy attention to capitation in Ghana. Cross-sectional qualitative data were gathered in December, 2019 from semi-structured interviews with a purposive sample of 18 stakeholders and complemented with four community-level focus group discussions with 41 policy beneficiaries in the pilot region. All data were tape-recorded and transcribed. The analysis was thematic, using the NVivo 12 software. The results revealed that an appropriate reframing of the policy requires policy renaming, refinement of certain policy design characteristics (emergency care, capitation rates, choice and assignment of providers) and refocusing policy communication and advocacy on the health benefits of capitation instead of its cost containment intent. To create political opportunities for policy re-implementation, a politically sensitive approach with broader stakeholder consultations should be adopted. Policy advocacy and communication should be evidenced-based and led by politically neutral agents. An equitable capitation policy implementation requires resourcing health facilities, especially the lower-level facilities, with improved infrastructure, consumables, improved information management systems and well-trained personnel to enhance their service delivery capacities. The study concludes that there exists stakeholder interest in the capitation policy in Ghana and calls for an effective reframing, creation of political opportunities, and mobilization of needed resources to regain policy attention.
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Affiliation(s)
- Gilbert Abotisem Abiiro
- Department of Health Services, Policy, Planning, Management and Economics, School of Public Health, University for Development Studies, Tamale, Ghana
- Department of Population and Reproductive Health, School of Public Health, University for Development Studies, Tamale, Ghana
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Are C, Murthy SS, Sullivan R, Schissel M, Chowdhury S, Alatise O, Anaya D, Are M, Balch C, Bartlett D, Brennan M, Cairncross L, Clark M, Deo SVS, Dudeja V, D'Ugo D, Fadhil I, Giuliano A, Gopal S, Gutnik L, Ilbawi A, Jani P, Kingham TP, Lorenzon L, Leiphrakpam P, Leon A, Martinez-Said H, McMasters K, Meltzer DO, Mutebi M, Zafar SN, Naik V, Newman L, Oliveira AF, Park DJ, Pramesh CS, Rao S, Subramanyeshwar Rao T, Bargallo-Rocha E, Romanoff A, Rositch AF, Rubio IT, Salvador de Castro Ribeiro H, Sbaity E, Senthil M, Smith L, Toi M, Turaga K, Yanala U, Yip CH, Zaghloul A, Anderson BO. Global Cancer Surgery: pragmatic solutions to improve cancer surgery outcomes worldwide. Lancet Oncol 2023; 24:e472-e518. [PMID: 37924819 DOI: 10.1016/s1470-2045(23)00412-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 11/06/2023]
Abstract
The first Lancet Oncology Commission on Global Cancer Surgery was published in 2015 and serves as a landmark paper in the field of cancer surgery. The Commission highlighted the burden of cancer and the importance of cancer surgery, while documenting the many inadequacies in the ability to deliver safe, timely, and affordable cancer surgical care. This Commission builds on the first Commission by focusing on solutions and actions to improve access to cancer surgery globally, developed by drawing upon the expertise from cancer surgery leaders across the world. We present solution frameworks in nine domains that can improve access to cancer surgery. These nine domains were refined to identify solutions specific to the six WHO regions. On the basis of these solutions, we developed eight actions to propel essential improvements in the global capacity for cancer surgery. Our initiatives are broad in scope, pragmatic, affordable, and contextually applicable, and aimed at cancer surgeons as well as leaders, administrators, elected officials, and health policy advocates. We envision that the solutions and actions contained within the Commission will address inequities and promote safe, timely, and affordable cancer surgery for every patient, regardless of their socioeconomic status or geographic location.
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Affiliation(s)
- Chandrakanth Are
- Division of Surgical Oncology, Department of Surgery, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Shilpa S Murthy
- Division of Surgical Oncology, Department of Surgery, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Richard Sullivan
- Institute of Cancer Policy, School of Cancer Sciences, King's College London, London, UK
| | - Makayla Schissel
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sanjib Chowdhury
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Olesegun Alatise
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Daniel Anaya
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Madhuri Are
- Division of Pain Medicine, Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Charles Balch
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, Global Cancer Surgery: pragmatic solutions to improve USA
| | - David Bartlett
- Department of Surgery, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - Murray Brennan
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lydia Cairncross
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Matthew Clark
- University of Auckland School of Medicine, Auckland, New Zealand
| | - S V S Deo
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Vikas Dudeja
- Division of Surgical Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Domenico D'Ugo
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | | | - Armando Giuliano
- Cedars-Sinai Medical Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Satish Gopal
- Center for Global Health, National Cancer Institute, Washington DC, USA
| | - Lily Gutnik
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andre Ilbawi
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Pankaj Jani
- Department of Surgery, University of Nairobi, Nairobi, Kenya
| | | | - Laura Lorenzon
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | - Premila Leiphrakpam
- Division of Surgical Oncology, Department of Surgery, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Augusto Leon
- Department of Surgical Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Kelly McMasters
- Division of Surgical Oncology, Hiram C Polk, Jr MD Department of Surgery, University of Louisville, Louisville, KY, USA
| | - David O Meltzer
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Miriam Mutebi
- Department of Surgery, Aga Khan University Hospital, Nairobi, Kenya
| | - Syed Nabeel Zafar
- Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, WI, USA
| | - Vibhavari Naik
- Department of Anesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | - Lisa Newman
- Department of Surgery, New York-Presbyterian, Weill Cornell Medicine, New York, NY, USA
| | | | - Do Joong Park
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - C S Pramesh
- Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Centre, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Saieesh Rao
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - T Subramanyeshwar Rao
- Department of Surgical Oncology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | | | - Anya Romanoff
- Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Isabel T Rubio
- Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Spain
| | | | - Eman Sbaity
- Division of General Surgery, Department of Surgery, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Maheswari Senthil
- Division of Surgical Oncology, Department of Surgery, University of California, Irvine, Irvine, CA, USA
| | - Lynette Smith
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Masakazi Toi
- Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Tokyo, Japan
| | - Kiran Turaga
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Ujwal Yanala
- Surgical Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Cheng-Har Yip
- Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
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Yap A, Olatunji BT, Negash S, Mweru D, Kisembo S, Masumbuko F, Ameh EA, Lebbie A, Bvulani B, Hansen E, Philipo GS, Carroll M, Hsu PJ, Bryce E, Cheung M, Fedatto M, Laverde R, Ozgediz D. Out-of-pocket costs and catastrophic healthcare expenditure for families of children requiring surgery in sub-Saharan Africa. Surgery 2023; 174:567-573. [PMID: 37385869 DOI: 10.1016/j.surg.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/04/2023] [Accepted: 05/24/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Out-of-pocket healthcare costs leading to catastrophic healthcare expenditure pose a financial threat for families of children undergoing surgery in Sub-Saharan African countries, where universal healthcare coverage is often insufficient. METHODS A prospective clinical and socioeconomic data collection tool was used in African hospitals with dedicated pediatric operating rooms installed philanthropically. Clinical data were collected via chart review and socioeconomic data from families. The primary indicator of economic burden was the proportion of families with catastrophic healthcare expenditures. Secondary indicators included the percentage who borrowed money, sold possessions, forfeited wages, and lost a job secondary to their child's surgery. Descriptive statistics and multivariate logistic regression were performed to identify predictors of catastrophic healthcare expenditure. RESULTS In all, 2,296 families of pediatric surgical patients from 6 countries were included. The median annual income was $1,000 (interquartile range 308-2,563), whereas the median out-of-pocket cost was $60 (interquartile range 26-174). Overall, 39.9% (n = 915) families incurred catastrophic healthcare expenditure, 23.3% (n = 533) borrowed money, 3.8% (n = 88%) sold possessions, 26.4% (n = 604) forfeited wages, and 2.3% (n = 52) lost a job because of the child's surgery. Catastrophic healthcare expenditure was associated with older age, emergency cases, need for transfusion, reoperation, antibiotics, and longer length of stay, whereas the subgroup analysis found insurance to be protective (odds ratio 0.22, P = .002). CONCLUSION A full 40% of families of children in sub-Saharan Africa who undergo surgery incur catastrophic healthcare expenditure, shouldering economic consequences such as forfeited wages and debt. Intensive resource utilization and reduced insurance coverage in older children may contribute to a higher likelihood of catastrophic healthcare expenditure and can be insurance targets for policymakers.
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Affiliation(s)
- Ava Yap
- Center of Health Equity in Surgery and Anesthesia, University of California San Francisco, San Francisco, CA.
| | | | - Samuel Negash
- Department of Paediatric Surgery, Menelik II Hospital, Addis Ababa, Ethiopia
| | - Dilon Mweru
- Department of Surgery, Centre Hospitalier Bethesda, Goma, Democratic Republic of Congo
| | - Steve Kisembo
- Department of Surgery, Centre Hospitalier Bethesda, Goma, Democratic Republic of Congo
| | - Franck Masumbuko
- Department of Surgery, Hôpital Provincial Général de Reférence de Bukavu, Bukavu, Democratic Republic of Congo
| | - Emmanuel A Ameh
- Department of Paediatric Surgery, National Hospital Abuja, Abuja, Nigeria
| | - Aiah Lebbie
- Department of Surgery, Connaught Hospital, Freetown, Sierra Leone
| | - Bruce Bvulani
- Department of Surgery, University Teaching Hospital, Lusaka, Zambia
| | - Eric Hansen
- Department of Surgery, Kijabe Hospital, Kijabe, Kenya
| | | | - Madeleine Carroll
- Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Phillip J Hsu
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Emma Bryce
- Kids Operating Room, Edinburgh, Scotland, United Kingdom; Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Maija Cheung
- Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Maira Fedatto
- Kids Operating Room, Edinburgh, Scotland, United Kingdom
| | - Ruth Laverde
- Center of Health Equity in Surgery and Anesthesia, University of California San Francisco, San Francisco, CA
| | - Doruk Ozgediz
- Center of Health Equity in Surgery and Anesthesia, University of California San Francisco, San Francisco, CA
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Kwasau H, Kamanda J, Lebbie A, Cotache-Condor C, Espinoza P, Grimm A, Wright N, Smith E. Prevalence and outcomes of pediatric surgical conditions at Connaught Hospital in Freetown: a retrospective study. WORLD JOURNAL OF PEDIATRIC SURGERY 2023; 6:e000473. [PMID: 38328392 PMCID: PMC10848619 DOI: 10.1136/wjps-2022-000473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 02/01/2023] [Indexed: 02/25/2023] Open
Abstract
Background Sub-Saharan Africa experiences a disproportionate amount of pediatric surgical disease, with 80% of children lacking access to timely, affordable, and safe surgical care. This study aims to characterize the burden of disease and outcomes of pediatric surgical conditions at Connaught Hospital, the main pediatric referral hospital in Sierra Leone. Methods This retrospective and hospital-based study included children up to 15 years old who were operated on between 2015 and June 2016 at Connaught Hospital in Freetown, Sierra Leone. Descriptive and inferential statistics were used to characterize the distribution of disease and compare all variables against age category and mortality. Findings A total of 215 patients were included in this study of which 72.5% (n=132) were male and 27.5% (n=50) were female. Most of the patients were diagnosed with congenital anomalies (60.9%; n=131). However, infection was the leading diagnosis (60.5%; n=23) among patients aged 5-10 years (n=38). Inguinal hernia was the leading condition (65.0%; n=85) among patients presenting with a congenital anomaly. The condition with the highest mortality was infections (17.0%; n=8), followed by other conditions (9.1%; n=2) and congenital anomalies (3.1%; n=4). Based on the results of this study, over 7000 children with inguinal hernias remain untreated annually in Freetown, Sierra Leone. Conclusion This study quantifies the burden of surgical disease among children, a foundational step toward the prioritization of pediatric surgical care in national health agendas, the development of evidence-based interventions, and the strategic allocation of resources in Sierra Leone.
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Affiliation(s)
- Henang Kwasau
- Department of Community Health, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Juliana Kamanda
- Department of Community Health, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Aiah Lebbie
- Department of Community Health, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Cesia Cotache-Condor
- Department of Surgery, Duke School of Medicine, Duke University, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Duke Center for Global Surgery and Health Equity, Duke University, Durham, North Carolina, USA
| | - Pamela Espinoza
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Andie Grimm
- Department of Public Health, Baylor University, Waco, Texas, USA
| | - Naomi Wright
- King’s Centre for Global Health and Health Partnerships, King's College London, London, UK
| | - Emily Smith
- Department of Surgery, Duke School of Medicine, Duke University, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Duke Center for Global Surgery and Health Equity, Duke University, Durham, North Carolina, USA
- Department of Emergency Medicine, Duke School of Medicine, Duke University, Durham, North Carolina, USA
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5
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Lawler M, Davies L, Oberst S, Oliver K, Eggermont A, Schmutz A, La Vecchia C, Allemani C, Lievens Y, Naredi P, Cufer T, Aggarwal A, Aapro M, Apostolidis K, Baird AM, Cardoso F, Charalambous A, Coleman MP, Costa A, Crul M, Dégi CL, Di Nicolantonio F, Erdem S, Geanta M, Geissler J, Jassem J, Jagielska B, Jonsson B, Kelly D, Kelm O, Kolarova T, Kutluk T, Lewison G, Meunier F, Pelouchova J, Philip T, Price R, Rau B, Rubio IT, Selby P, Južnič Sotlar M, Spurrier-Bernard G, van Hoeve JC, Vrdoljak E, Westerhuis W, Wojciechowska U, Sullivan R. European Groundshot-addressing Europe's cancer research challenges: a Lancet Oncology Commission. Lancet Oncol 2023; 24:e11-e56. [PMID: 36400101 DOI: 10.1016/s1470-2045(22)00540-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022]
Abstract
Cancer research is a crucial pillar for countries to deliver more affordable, higher quality, and more equitable cancer care. Patients treated in research-active hospitals have better outcomes than patients who are not treated in these settings. However, cancer in Europe is at a crossroads. Cancer was already a leading cause of premature death before the COVID-19 pandemic, and the disastrous effects of the pandemic on early diagnosis and treatment will probably set back cancer outcomes in Europe by almost a decade. Recognising the pivotal importance of research not just to mitigate the pandemic today, but to build better European cancer services and systems for patients tomorrow, the Lancet Oncology European Groundshot Commission on cancer research brings together a wide range of experts, together with detailed new data on cancer research activity across Europe during the past 12 years. We have deployed this knowledge to help inform Europe's Beating Cancer Plan and the EU Cancer Mission, and to set out an evidence-driven, patient-centred cancer research roadmap for Europe. The high-resolution cancer research data we have generated show current activities, captured through different metrics, including by region, disease burden, research domain, and effect on outcomes. We have also included granular data on research collaboration, gender of researchers, and research funding. The inclusion of granular data has facilitated the identification of areas that are perhaps overemphasised in current cancer research in Europe, while also highlighting domains that are underserved. Our detailed data emphasise the need for more information-driven and data-driven cancer research strategies and planning going forward. A particular focus must be on central and eastern Europe, because our findings emphasise the widening gap in cancer research activity, and capacity and outcomes, compared with the rest of Europe. Citizens and patients, no matter where they are, must benefit from advances in cancer research. This Commission also highlights that the narrow focus on discovery science and biopharmaceutical research in Europe needs to be widened to include such areas as prevention and early diagnosis; treatment modalities such as radiotherapy and surgery; and a larger concentration on developing a research and innovation strategy for the 20 million Europeans living beyond a cancer diagnosis. Our data highlight the important role of comprehensive cancer centres in driving the European cancer research agenda. Crucial to a functioning cancer research strategy and its translation into patient benefit is the need for a greater emphasis on health policy and systems research, including implementation science, so that the innovative technological outputs from cancer research have a clear pathway to delivery. This European cancer research Commission has identified 12 key recommendations within a call to action to reimagine cancer research and its implementation in Europe. We hope this call to action will help to achieve our ambitious 70:35 target: 70% average 10-year survival for all European cancer patients by 2035.
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Affiliation(s)
- Mark Lawler
- Patrick G Johnston Centre for Cancer Research, Faculty of Medicine, Health and Life Sciences, Queen's University Belfast, Belfast, UK.
| | - Lynne Davies
- International Cancer Research Partnership, International House, Cardiff, UK
| | - Simon Oberst
- Organisation of European Cancer Institutes, Brussels, Belgium
| | - Kathy Oliver
- International Brain Tumour Alliance, Tadworth, UK; European Cancer Organisation Patient Advisory Committee, Brussels, Belgium
| | - Alexander Eggermont
- Faculty of Medicine, Utrecht University Medical Center, Utrecht, Netherlands; Princess Máxima Centrum, Utrecht, Netherlands
| | - Anna Schmutz
- International Agency for Cancer Research, Lyon, France
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Claudia Allemani
- Cancer Survival Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University and Ghent University Hospital, Ghent, Belgium
| | - Peter Naredi
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tanja Cufer
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK; Institute of Cancer Policy, King's College London, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Matti Aapro
- Genolier Cancer Center, Genolier, Switzerland
| | - Kathi Apostolidis
- Hellenic Cancer Federation, Athens, Greece; European Cancer Patient Coalition, Brussels, Belgium
| | - Anne-Marie Baird
- Lung Cancer Europe, Bern, Switzerland; Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Fatima Cardoso
- Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - Andreas Charalambous
- European Cancer Organisation Brussels, Brussels, Belgium; Department of Nursing, Cyprus University of Technology, Limassol, Cyprus; Department of Oncology, University of Turku, Turku, Finland
| | - Michel P Coleman
- Cancer Survival Group, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Csaba L Dégi
- Faculty of Sociology and Social Work, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Federica Di Nicolantonio
- Department of Oncology, University of Turin, Turin, Italy; Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Sema Erdem
- European Cancer Organisation Patient Advisory Committee, Europa Donna, Istanbul, Türkiye
| | - Marius Geanta
- Centre for Innovation in Medicine and Kol Medical Media, Bucharest, Romania
| | - Jan Geissler
- Patvocates and CML Advocates Network, Leukaemie-Online (LeukaNET), Munich, Germany
| | | | - Beata Jagielska
- Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Daniel Kelly
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Olaf Kelm
- International Agency for Research on Cancer, Lyon, France
| | | | - Tezer Kutluk
- Faculty of Medicine & Cancer Institute, Hacettepe University, Ankara, Türkiye
| | - Grant Lewison
- Institute of Cancer Policy, School of Cancer Sciences, Kings College London, London, UK
| | | | | | - Thierry Philip
- Organisation of European Cancer Institutes, Brussels, Belgium; Institut Curie, Paris, France
| | - Richard Price
- European Cancer Organisation Brussels, Brussels, Belgium
| | - Beate Rau
- Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - Peter Selby
- School of Medicine, University of Leeds, Leeds, UK
| | | | | | - Jolanda C van Hoeve
- Organisation of European Cancer Institutes, Brussels, Belgium; Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
| | - Eduard Vrdoljak
- Department of Oncology, University Hospital Center Split, School of Medicine, University of Split, Split, Croatia
| | - Willien Westerhuis
- Organisation of European Cancer Institutes, Brussels, Belgium; Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
| | | | - Richard Sullivan
- Institute of Cancer Policy, School of Cancer Sciences, Kings College London, London, UK
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6
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Robertson FC, Gnanakumar S, Karekezi C, Vaughan K, Garcia RM, Abou El Ela Bourquin B, Derkaoui Hassani F, Alamri A, Mentri N, Höhne J, Laeke T, Al-Jehani H, Moscote-Salazar LR, Al-Ahmari AN, Samprón N, Stienen MN, Nicolosi F, Fontoura Solla DJ, Adelson PD, Servadei F, Al-Habib A, Esene I, Kolias AG. The World Federation of Neurosurgical Societies Young Neurosurgeons Survey (Part II): Barriers to Professional Development and Service Delivery in Neurosurgery. World Neurosurg X 2020; 8:100084. [PMID: 33103110 PMCID: PMC7573643 DOI: 10.1016/j.wnsx.2020.100084] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Strengthening health systems requires attention to workforce, training needs, and barriers to service delivery. The World Federation of Neurosurgical Societies Young Neurosurgeons Committee survey sought to identify challenges for residents, fellows, and consultants within 10 years of training. METHODS An online survey was distributed to various neurosurgical societies, personal contacts, and social media platforms (April-November 2018). Responses were grouped by World Bank income classification into high-income countries (HICs), upper middle-income countries (UMICs), low-middle-income countries (LMICs), and low-income countries (LICs). Descriptive statistical analysis was performed. RESULTS In total, 953 individuals completed the survey. For service delivery, the limited number of trained neurosurgeons was seen as a barrier for 12.5%, 29.8%, 69.2%, and 23.9% of respondents from HICs, UMICs, LMICs, and LICs, respectively (P < 0.0001). The most reported personal challenge was the lack of opportunities for research (HICs, 34.6%; UMICs, 57.5%; LMICs, 61.6%; and LICs, 61.5%; P = 0.03). Other differences by income class included limited access to advice from experienced/senior colleagues (P < 0.001), neurosurgical journals (P < 0.0001), and textbooks (P = 0.02). Assessing how the World Federation of Neurosurgical Societies could best help young neurosurgeons, the most frequent requests (n = 953; 1673 requests) were research (n = 384), education (n = 296), and subspecialty/fellowship training (n = 232). Skills courses and access to cadaver dissection laboratories were also heavily requested. CONCLUSIONS Young neurosurgeons perceived that additional neurosurgeons are needed globally, especially in LICs and LMICs, and primarily requested additional resources for research and subspecialty training.
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Affiliation(s)
- Faith C. Robertson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sujit Gnanakumar
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Claire Karekezi
- Department of Neurosurgery, Rwanda Military Hospital, Kigali, Rwanda
| | - Kerry Vaughan
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Roxanna M. Garcia
- Department of Neurosurgery, Northwestern University, Chicago, Illinois, USA
| | - Bilal Abou El Ela Bourquin
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Fahd Derkaoui Hassani
- Department of Neurosurgery, Cheikh Zaid International Hospital, Abulcasis International University of Health Sciences, Rabat, Morocco
| | - Alexander Alamri
- Department of Neurosurgery, The Royal London Hospital, London, United Kingdom
| | - Nesrine Mentri
- Department of Neurosurgery, Bejaia University Hospital, Bejaia, Algeria
| | - Julius Höhne
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
| | - Tsegazeab Laeke
- National Institute for Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Department of Surgery, Neurosurgery Unit, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - Hosam Al-Jehani
- Department of Neurosurgery, King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University, Al-Khobar, Saudi Arabia
- Neuroscience Center, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | | | - Ahmed Nasser Al-Ahmari
- Division of Neurosurgery, Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Nicolás Samprón
- Servicio de Neurocirugía, Hospital Universitario Donostia, San Sebastián, Spain
| | - Martin N. Stienen
- Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Switzerland
| | - Federico Nicolosi
- Department of Neurosurgery, Humanitas University and Research Hospital, Rozzano, Milan, Italy
| | | | - P. David Adelson
- Barrow Neurological Institute at Phoenix Children’s Hospital, Phoenix, Arizona, USA
| | - Franco Servadei
- Department of Neurosurgery, Humanitas University and Research Hospital, Rozzano, Milan, Italy
| | - Amro Al-Habib
- Division of Neurosurgery, Department of Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Ignatius Esene
- Neurosurgery Division, Department of Surgery, University of Bamenda, Bamenda, Cameroon
| | - Angelos G. Kolias
- National Institute for Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke’s Hospital, Cambridge, United Kingdom
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7
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Chen QY, Liu ZY, Zhong Q, Xie JW, Wang JB, Lin JX, Lu J, Cao LL, Lin M, Tu RH, Huang ZN, Lin JL, Zheng HL, Li P, Zheng CH, Huang CM. Clinical Impact of Delayed Initiation of Adjuvant Chemotherapy Among Patients With Stage II/III Gastric Cancer: Can We Do Better? Front Oncol 2020; 10:1149. [PMID: 32850326 PMCID: PMC7412732 DOI: 10.3389/fonc.2020.01149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/08/2020] [Indexed: 12/24/2022] Open
Abstract
Background: To investigate the prognostic effects and risk factors of the omission and delay of postoperative chemotherapy of stage II/III gastric cancer (GC). Methods: The clinicopathological data of 1,520 patients undergoing radical gastrectomy for stage II/III GC were collected and retrospectively analyzed. We defined the chemotherapy delayed until more than 60 days after radical gastrectomy and the complete omission of chemotherapy as unacceptable chemotherapy initiation (UAC), whereas the chemotherapy conducted within 60 days of radical gastrectomy was defined as acceptable chemotherapy initiation (AC). The survival between the two groups was compared, and the trends and risk factors of UAC were analyzed. Results: There were 539 (35.5%) patients with UAC. The overall survival (OS) and disease-free survival of the UAC group patients were significantly inferior to those in the AC group (p < 0.001). Cox multivariate analysis demonstrated that UAC is an independent predictor of OS (p < 0.05). The OS and disease-free survival of the patients in the UAC group were close to those of the patients without chemotherapy (p > 0.05). Logistic analysis showed that female, old age, a self-paid status, a very low social status, high American Society of Anesthesiologists scores, intra-abdominal surgery history, and serious postoperative complications were independent risk factors of UAC (all p < 0.05). The radar chart shows the risk factors of UAC changed with time. Conclusions: UAC after radical gastrectomy is an independent risk factor for the prognosis of stage II/III GC patients. However, no significant decline of UAC has been achieved recently and should call for the attention of both government and clinicians.
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Affiliation(s)
- Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Zhi-Yu Liu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Qing Zhong
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Long-Long Cao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Mi Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ru-Hong Tu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ze-Ning Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ju-Li Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Hua-Long Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
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8
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Robertson FC, Esene IN, Kolias AG, Khan T, Rosseau G, Gormley WB, Park KB, Broekman ML. Global Perspectives on Task Shifting and Task Sharing in Neurosurgery. World Neurosurg X 2020; 6:100060. [PMID: 32309801 PMCID: PMC7154229 DOI: 10.1016/j.wnsx.2019.100060] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 08/28/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Neurosurgical task shifting and task sharing (TS/S), delegating clinical care to non-neurosurgeons, is ongoing in many hospital systems in which neurosurgeons are scarce. Although TS/S can increase access to treatment, it remains highly controversial. This survey investigated perceptions of neurosurgical TS/S to elucidate whether it is a permissible temporary solution to the global workforce deficit. METHODS The survey was distributed to a convenience sample of individuals providing neurosurgical care. A digital survey link was distributed through electronic mailing lists of continental neurosurgical societies and various collectives, conference announcements, and social media platforms (July 2018-January 2019). Data were analyzed by descriptive statistics and univariate regression of Likert Scale scores. RESULTS Survey respondents represented 105 of 194 World Health Organization member countries (54.1%; 391 respondents, 162 from high-income countries and 229 from low- and middle-income countries [LMICs]). The most agreed on statement was that task sharing is preferred to task shifting. There was broad consensus that both task shifting and task sharing should require competency-based evaluation, standardized training endorsed by governing organizations, and maintenance of certification. When perspectives were stratified by income class, LMICs were significantly more likely to agree that task shifting is professionally disruptive to traditional training, task sharing should be a priority where human resources are scarce, and to call for additional TS/S regulation, such as certification and formal consultation with a neurosurgeon (in person or electronic/telemedicine). CONCLUSIONS Both LMIC and high-income countries agreed that task sharing should be prioritized over task shifting and that additional recommendations and regulations could enhance care. These data invite future discussions on policy and training programs.
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Affiliation(s)
- Faith C. Robertson
- Harvard Medical School, Boston, Massachusetts, USA
- Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ignatius N. Esene
- Neurosurgery Division, Department of Surgery, University of Bamenda, Bamenda, Cameroon
| | - Angelos G. Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke's Hospital, Cambridge, United Kingdom
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Tariq Khan
- Department of Biotechnology, University of Malakand, Chakdara Dir Lower, Pakistan
| | - Gail Rosseau
- Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - William B. Gormley
- Harvard Medical School, Boston, Massachusetts, USA
- Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Neurological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kee B. Park
- Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Marike L.D. Broekman
- Leiden University Medical Center, Neurosurgery, Leiden, the Netherlands
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, the Netherlands
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9
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Kakembo N, Godier-Furnemont A, Nabirye A, Cheung M, Kisa P, Muzira A, Sekabira J, Ozgediz D. Barriers to Pediatric Surgical Care in Low-Income Countries: The Three Delays' Impact in Uganda. J Surg Res 2019; 242:193-199. [PMID: 31085367 DOI: 10.1016/j.jss.2019.03.058] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 02/28/2019] [Accepted: 03/22/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND We sought to understand the challenges in accessing pediatric surgical care in the context of the "three delays" model at the Pediatric Surgery Outpatient Clinic (PSOPC) at a tertiary hospital in Kampala, Uganda. MATERIALS AND METHODS An outpatient database was established at the weekly PSOPC. A survey regarding prior healthcare visits and barriers to care was additionally administered to clinic patients and inpatients. RESULTS Patients first sought healthcare a median of 56 d before the current visit to the PSOPC. A majority (52%) of patients first sought care at another health facility, and 17% of those surveyed had presented to the PSOPC three or more times for their current medical issue. Of 240 patients with a new issue or due for their next surgery, 10% were admitted to the ward, with only 54% receiving definitive care. Included in the most commonly needed surgeries for PSOPC patients were herniotomy (16% inguinal; 14.9% umbilical), orchiopexy (6.3%), posterior sagittal anorectoplasty (6.3%), and colostomy closure (4.4%), with the range of patient ages at the time of presentation reflecting delays in care. Patient expenditures associated with travel to the hospital showed inpatients coming from significantly further away, with higher costs of travel and need to borrow or sell assets to cover travel costs, when compared with PSOPC patients. CONCLUSIONS Patients face significant delays in accessing and receiving definitive surgical care. Associated burdens associated with these delays place patients at risk for catastrophic health expenditures. Infrastructure and capacity development are necessary for improvement in pediatric surgical care.
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Affiliation(s)
- Nasser Kakembo
- Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda
| | | | - Ann Nabirye
- Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Maija Cheung
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Phyllis Kisa
- Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Arlene Muzira
- Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda
| | - John Sekabira
- Department of Surgery, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Doruk Ozgediz
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
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10
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Albutt K, Punchak M, Kayima P, Namanya DB, Anderson GA, Shrime MG. Access to Safe, Timely, and Affordable Surgical Care in Uganda: A Stratified Randomized Evaluation of Nationwide Public Sector Surgical Capacity and Core Surgical Indicators. World J Surg 2018; 42:2303-2313. [PMID: 29368021 DOI: 10.1007/s00268-018-4485-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Access to safe surgery is critical to health, welfare, and economic development. In 2015, the Lancet Commission on Global Surgery recommended that all countries collect surgical indicators to lend insight into improving surgical care. No nationwide high-quality data exist for these metrics in Uganda. METHODS A standardized quantitative hospital assessment and a semi-structured interview were administered to key stakeholders at 17 randomly selected public hospitals. Hospital walk-throughs and retrospective reviews of operative logbooks were completed. RESULTS This study captured information for public hospitals serving 64.0% of Uganda's population. On average, <25% of the population had 2 h access to a surgically capable facility. Hospitals averaged 257 beds/facilities and there were 0.2 operating rooms per 100,000 people. Annual surgical volume was 144.5 cases per 100,000 people per year. Surgical, anesthetic, and obstetrician physician workforce density was 0.3 per 100,000 people. Most hospitals reported having electricity, oxygen, and blood available more than half the time and running water available at least three quarters of the time. In total, 93.8% of facilities never had access to a CT scan. Sterile gloves, nasogastric tubes, and Foley catheters were frequently unavailable. Uniform outcome reporting does not exist, and the WHO safe surgery checklist is not utilized. CONCLUSION The Ugandan public hospital system does not meet LCoGS targets for surgical access, workforce, or surgical volume. Critical policy and programmatic developments are essential to build surgical capacity and facilitate provision of safe, timely, and affordable surgical care. Surgery must become a public health priority in Uganda and other low resource settings.
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Affiliation(s)
- Katherine Albutt
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA. .,Department of Surgery, Massachusetts General Hospital (MGH), Boston, MA, USA.
| | - Maria Punchak
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA.,David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Peter Kayima
- Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Didacus B Namanya
- Ministry of Health (MOH), Kampala, Uganda.,Uganda Martyrs University (UMU), Nkozi, Uganda
| | - Geoffrey A Anderson
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA.,Department of Surgery, Massachusetts General Hospital (MGH), Boston, MA, USA
| | - Mark G Shrime
- Program in Global Surgery and Social Change (PGSSC), Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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11
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Koch R, Roa L, Pyda J, Kerrigan M, Barthélemy E, Meara JG. The Bill & Melinda Gates Foundation: An opportunity to lead innovation in global surgery. Surgery 2018; 165:273-280. [PMID: 30316576 DOI: 10.1016/j.surg.2018.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 08/02/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The Bill and Melinda Gates Foundation has made unparalleled contributions to global health and human development by bringing together generous funding, strategic partnerships, and innovative leadership. For the last twenty years, the Gates Foundation has supported the expansion of programs that directly address the fundamental barriers to the advancement of marginalized communities around the globe, with a transformative focus on innovations to combat communicable diseases and to ensure maternal and child health. Despite the wide spectrum of programs, the Gates Foundation has not, as of yet, explicitly supported the development of surgical care. METHODS This article explores the pivotal role that the Gates Foundation could play in advancing the emerging global surgery agenda. First, we demonstrate the importance of the Gates Foundation's contributions by reviewing its history, growth, and evolution as a pioneering supporter of global health and human development. Recognizing the Foundation's use of metrics and data in strategic planning and action, we align the priorities of the Foundation with the growing recognition of surgical care as a critical component of efforts to ensure universal health care. RESULTS To promote healthy lives and well-being for all, development of quality and affordable capacity for surgery, obstetrics and anesthesia is more important than ever. We present the unique opportunity for the Gates Foundation to bring its transformative vision and programing to the effort to ensure equitable, timely, and quality surgical care around the world.
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Affiliation(s)
- Rachel Koch
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA; Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
| | - Lina Roa
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA; Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Canada
| | - Jordan Pyda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA; Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Monica Kerrigan
- Vice President, Jhpiego, Baltimore, MD; Family Planning Strategy, Bill & Melinda Gates Foundation, Seattle, WA
| | - Ernest Barthélemy
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA; Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA
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12
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Beyond a Moral Obligation: A Legal Framework for Emergency and Essential Surgical Care and Anesthesia. World J Surg 2017; 41:1208-1217. [DOI: 10.1007/s00268-016-3866-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Bendix P, Havens JM. The Global Burden of Surgical Disease. CURRENT TRAUMA REPORTS 2017. [DOI: 10.1007/s40719-017-0070-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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14
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Butler EK, Tran TM, Fuller AT, Brammell A, Vissoci JR, de Andrade L, Makumbi F, Luboga S, Muhumuza C, Ssennono VF, Chipman JG, Galukande M, Haglund MM, Smith ER. Quantifying the pediatric surgical need in Uganda: results of a nationwide cross-sectional, household survey. Pediatr Surg Int 2016; 32:1075-1085. [PMID: 27614904 PMCID: PMC5050237 DOI: 10.1007/s00383-016-3957-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2016] [Indexed: 02/05/2023]
Abstract
PURPOSE Little is known about the prevalence of pediatric surgical conditions in low- and middle-income countries. Many children never seek medical care, thus the true prevalence of surgical conditions in children in Uganda is unknown. The objective of this study was to determine the prevalence of surgical conditions in children in Uganda. METHODS Using the Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey, we enumerated 4248 individuals in 2315 households in 105 randomly selected clusters throughout Uganda. Children aged 0-18 were included if randomly selected from the household; for those who could not answer for themselves, parents served as surrogates. RESULTS Of 2176 children surveyed, 160 (7.4 %) reported a currently untreated surgical condition. Lifetime prevalence of surgical conditions was 14.0 % (305/2176). The predominant cause of surgical conditions was trauma (48.4 %), followed by wounds (19.7 %), acquired deformities (16.2 %), and burns (12.5 %). Of 90 pediatric household deaths, 31.1 % were associated with a surgically treatable proximate cause of death (28/90 deaths). CONCLUSION Although some trauma-related surgical burden among children can be adequately addressed at district hospitals, the need for diagnostics, human resources, and curative services for more severe trauma cases, congenital deformities, and masses outweighs the current capacity of hospitals and trained pediatric surgeons in Uganda.
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Affiliation(s)
- Elissa K. Butler
- Department of Surgery, University of Washington, Seattle, WA USA
| | - Tu M. Tran
- Duke University Global Health Institute, 310 Trent Drive, Durham, NC 27710 USA
| | - Anthony T. Fuller
- Division of Global Neurosurgery and Neuroscience, Duke University, Durham, NC USA ,Duke University School of Medicine, Durham, NC USA
| | | | - Joao Ricardo Vissoci
- Duke University Global Health Institute, 310 Trent Drive, Durham, NC 27710 USA ,Division of Global Neurosurgery and Neuroscience, Duke University, Durham, NC USA
| | - Luciano de Andrade
- State University of West of Parana, Unioeste, Foz do Iguaçu, Brazil ,Public Health Research Group, Unioeste, Toledo, Brazil
| | | | - Samuel Luboga
- Department of Anatomy, Makerere University School of Medicine, Kampala, Uganda
| | | | | | | | - Moses Galukande
- Department of Surgery, Makerere University College of Health Sciences, Kampala, Uganda
| | - Michael M. Haglund
- Duke University Global Health Institute, 310 Trent Drive, Durham, NC 27710 USA ,Division of Global Neurosurgery and Neuroscience, Duke University, Durham, NC USA ,Department of Neurosurgery, Duke University Medical Center, Durham, NC USA
| | - Emily R. Smith
- Duke University Global Health Institute, 310 Trent Drive, Durham, NC 27710 USA ,Division of Global Neurosurgery and Neuroscience, Duke University, Durham, NC USA
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15
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Mortality of emergency abdominal surgery in high-, middle- and low-income countries. Br J Surg 2016; 103:971-988. [PMID: 27145169 DOI: 10.1002/bjs.10151] [Citation(s) in RCA: 196] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 11/26/2015] [Accepted: 02/10/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). METHODS This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. RESULTS Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1·6 per cent at 24 h (high 1·1 per cent, middle 1·9 per cent, low 3·4 per cent; P < 0·001), increasing to 5·4 per cent by 30 days (high 4·5 per cent, middle 6·0 per cent, low 8·6 per cent; P < 0·001). Of the 578 patients who died, 404 (69·9 per cent) did so between 24 h and 30 days following surgery (high 74·2 per cent, middle 68·8 per cent, low 60·5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2·78, 95 per cent c.i. 1·84 to 4·20) and low-income (OR 2·97, 1·84 to 4·81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. CONCLUSION Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. REGISTRATION NUMBER NCT02179112 (http://www.clinicaltrials.gov).
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16
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Citron I, Chokotho L, Lavy C. Prioritisation of Surgery in the National Health Strategic Plans of Africa: A Systematic Review. World J Surg 2016; 40:779-83. [PMID: 26711637 PMCID: PMC4767853 DOI: 10.1007/s00268-015-3333-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Disease amenable to surgical intervention accounts for 11-15 % of world disability and there is increasing interest in surgery as a global public health issue. National Health Strategic Plans (NHSPs) reflect countries' long-term health priorities, plans and targets. These plans were analysed to assess the prioritisation of surgery as a public health issue in Africa. METHODS NHSPs of 43 independent Sub-Saharan African countries available in the public domain in March 2014 in French or English were searched electronically for key terms: surg*, ortho*, trauma, cancer, appendic*, laparotomy, HIV, tuberculosis, malaria. They were then searched manually for disease prevalence, targets, and human resources. RESULTS 19 % of NHSPs had no mention of surgery or surgical conditions. 63 % had five or less mentions of surgery. HIV and malaria had 3772 mentions across all the policies, compared to surgery with only 376 mentions. Trauma had 239 mentions, while the common surgical conditions of appendicitis, laparotomy and hernia had no mentions at all. Over 95 % of NHSPs specifically mentioned the prevalence of HIV, tuberculosis, malaria, infant mortality and maternal mortality. Whereas, the most commonly mentioned surgical condition for which a prevalence was given was trauma, in only 47 % of policies. All NHSPs had plans and measurable targets for the reduction of HIV and tuberculosis. Of the total 4064 health targets, only 2 % were related to surgical conditions or surgical care. 33 % of policies had no surgical targets. DISCUSSION NHSPs are the best available measure of health service and planning priorities. It is clear from our findings that surgery is poorly represented and that surgical conditions and surgical treatment are not widely recognised as a public health priority. Greater prioritisation of surgery in national health strategic policies is required to build resilient surgical systems.
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Affiliation(s)
- Isabelle Citron
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | | | - Chris Lavy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Shawar YR, Shiffman J, Spiegel DA. Generation of political priority for global surgery: a qualitative policy analysis. LANCET GLOBAL HEALTH 2015; 3:e487-e495. [DOI: 10.1016/s2214-109x(15)00098-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 03/05/2015] [Accepted: 03/10/2015] [Indexed: 11/25/2022]
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