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Al-Fadhl MD, Karam MN, Chen J, Zackariya SK, Lain MC, Bales JR, Higgins AB, Laing JT, Wang HS, Andrews MG, Thomas AV, Smith L, Fox MD, Zackariya SK, Thomas SJ, Tincher AM, Al-Fadhl HD, Weston M, Marsh PL, Khan HA, Thomas EJ, Miller JB, Bailey JA, Koenig JJ, Waxman DA, Srikureja D, Fulkerson DH, Fox S, Bingaman G, Zimmer DF, Thompson MA, Bunch CM, Walsh MM. Traumatic Brain Injury as an Independent Predictor of Futility in the Early Resuscitation of Patients in Hemorrhagic Shock. J Clin Med 2024; 13:3915. [PMID: 38999481 PMCID: PMC11242176 DOI: 10.3390/jcm13133915] [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: 04/01/2024] [Revised: 06/08/2024] [Accepted: 06/26/2024] [Indexed: 07/14/2024] Open
Abstract
This review explores the concept of futility timeouts and the use of traumatic brain injury (TBI) as an independent predictor of the futility of resuscitation efforts in severely bleeding trauma patients. The national blood supply shortage has been exacerbated by the lingering influence of the COVID-19 pandemic on the number of blood donors available, as well as by the adoption of balanced hemostatic resuscitation protocols (such as the increasing use of 1:1:1 packed red blood cells, plasma, and platelets) with and without early whole blood resuscitation. This has underscored the urgent need for reliable predictors of futile resuscitation (FR). As a result, clinical, radiologic, and laboratory bedside markers have emerged which can accurately predict FR in patients with severe trauma-induced hemorrhage, such as the Suspension of Transfusion and Other Procedures (STOP) criteria. However, the STOP criteria do not include markers for TBI severity or transfusion cut points despite these patients requiring large quantities of blood components in the STOP criteria validation cohort. Yet, guidelines for neuroprognosticating patients with TBI can require up to 72 h, which makes them less useful in the minutes and hours following initial presentation. We examine the impact of TBI on bleeding trauma patients, with a focus on those with coagulopathies associated with TBI. This review categorizes TBI into isolated TBI (iTBI), hemorrhagic isolated TBI (hiTBI), and polytraumatic TBI (ptTBI). Through an analysis of bedside parameters (such as the proposed STOP criteria), coagulation assays, markers for TBI severity, and transfusion cut points as markers of futilty, we suggest amendments to current guidelines and the development of more precise algorithms that incorporate prognostic indicators of severe TBI as an independent parameter for the early prediction of FR so as to optimize blood product allocation.
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Affiliation(s)
- Mahmoud D Al-Fadhl
- Department of Medical Education, South Bend Campus, Indiana University School of Medicine, South Bend, IN 46617, USA
| | - Marie Nour Karam
- Department of Medical Education, South Bend Campus, Indiana University School of Medicine, South Bend, IN 46617, USA
| | - Jenny Chen
- Department of Medical Education, South Bend Campus, Indiana University School of Medicine, South Bend, IN 46617, USA
| | - Sufyan K Zackariya
- Department of Medical Education, South Bend Campus, Indiana University School of Medicine, South Bend, IN 46617, USA
| | - Morgan C Lain
- Department of Medical Education, South Bend Campus, Indiana University School of Medicine, South Bend, IN 46617, USA
| | - John R Bales
- Department of Medical Education, South Bend Campus, Indiana University School of Medicine, South Bend, IN 46617, USA
| | - Alexis B Higgins
- Department of Medical Education, South Bend Campus, Indiana University School of Medicine, South Bend, IN 46617, USA
| | - Jordan T Laing
- Department of Medical Education, South Bend Campus, Indiana University School of Medicine, South Bend, IN 46617, USA
| | - Hannah S Wang
- Department of Medical Education, South Bend Campus, Indiana University School of Medicine, South Bend, IN 46617, USA
| | - Madeline G Andrews
- Department of Medical Education, South Bend Campus, Indiana University School of Medicine, South Bend, IN 46617, USA
| | - Anthony V Thomas
- Department of Medical Education, South Bend Campus, Indiana University School of Medicine, South Bend, IN 46617, USA
| | - Leah Smith
- Department of Medical Education, South Bend Campus, Indiana University School of Medicine, South Bend, IN 46617, USA
| | - Mark D Fox
- Department of Medical Education, South Bend Campus, Indiana University School of Medicine, South Bend, IN 46617, USA
| | - Saniya K Zackariya
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA
| | - Samuel J Thomas
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA
| | - Anna M Tincher
- Department of Medical Education, South Bend Campus, Indiana University School of Medicine, South Bend, IN 46617, USA
| | - Hamid D Al-Fadhl
- Department of Medical Education, South Bend Campus, Indiana University School of Medicine, South Bend, IN 46617, USA
| | - May Weston
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA
| | - Phillip L Marsh
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA
| | - Hassaan A Khan
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA
| | - Emmanuel J Thomas
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA
| | - Joseph B Miller
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI 48202, USA
| | - Jason A Bailey
- Department of Emergency Medicine, Elkhart General Hospital, Elkhart, IN 46515, USA
| | - Justin J Koenig
- Department of Trauma & Surgical Services, Memorial Hospital, South Bend, IN 46601, USA
| | - Dan A Waxman
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46601, USA
- Versiti Blood Center of Indiana, Indianapolis, IN 46208, USA
| | - Daniel Srikureja
- Department of Surgery, Memorial Hospital, South Bend, IN 46601, USA
| | - Daniel H Fulkerson
- Department of Trauma & Surgical Services, Memorial Hospital, South Bend, IN 46601, USA
- Department of Neurosurgery, Memorial Hospital, South Bend, IN 46601, USA
| | - Sarah Fox
- Department of Trauma & Surgical Services, Memorial Hospital, South Bend, IN 46601, USA
| | - Greg Bingaman
- Department of Trauma & Surgical Services, Memorial Hospital, South Bend, IN 46601, USA
| | - Donald F Zimmer
- Department of Emergency Medicine, Memorial Hospital, South Bend, IN 46601, USA
| | - Mark A Thompson
- Department of Surgery, Memorial Hospital, South Bend, IN 46601, USA
| | - Connor M Bunch
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI 48202, USA
| | - Mark M Walsh
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN 46545, USA
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Jamil H, Ranganathan S, Fissha AB, Vinck EE, Vervoort D. Low-Cost Innovations in Global Cardiac Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2024:15569845241252441. [PMID: 38828943 DOI: 10.1177/15569845241252441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Cardiovascular diseases are the leading cause of morbidity and mortality worldwide, costing the lives of 18 million people annually, with up to one-third being attributable to cardiac surgical conditions. Approximately 6 billion people do not have access to safe, timely, and affordable cardiac surgery, predominantly affecting populations living in low-middle income countries. Cardiac surgical care is costly, resulting in few centers in variable-resource contexts operating continuously or with the resources observed in higher-resource environments. As a result, innovations may be formally developed or informally adopted to bypass resource constraints and ensure care delivery. Innovations have been observed across the cardiac surgical care continuum and across settings, potentially benefiting both high-income countries, where growing health care costs are becoming unsustainable, and low- and middle-income countries, where competing health agendas may limit investments into cardiac surgery. This narrative review attempts to address the costs associated with cardiac surgery, placing an emphasis on frugal innovations in the perioperative and postoperative care spectrum.
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Affiliation(s)
- Hera Jamil
- Life Sciences, Department of Biological Sciences, University of Toronto Scarborough, ON, Canada
| | | | - Aemon B Fissha
- College of Health Sciences, School of Medicine, Addis Ababa University, Ethiopia
| | - Eric E Vinck
- Division of Cardiac Surgery, Pontifical Bolivarian University, Medellín, Colombia
| | - Dominique Vervoort
- Division of Cardiac Surgery, University of Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, ON, Canada
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Nepogodiev D, Ismail L, Meara JG, Roslani AC, Harrison EM, Bhangu A. Strengthening health systems through surgery. Lancet 2024; 403:2358-2360. [PMID: 38782001 DOI: 10.1016/s0140-6736(24)01031-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024]
Affiliation(s)
- Dmitri Nepogodiev
- NIHR Global Health Research Unit on Global Surgery, Institute of Applied Health Research, Institute of Translational Medicine, University of Birmingham, Birmingham B15 2TH, UK.
| | - Lawani Ismail
- Department of Visceral Surgery, University of Abomey-Calavi Faculty of Health Sciences, Cotonou, Benin
| | - John G Meara
- Program in Global Surgery and Social Change and Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - April C Roslani
- Department of Surgery, University Malaya Medical Centre and Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Ewen M Harrison
- Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK
| | - Aneel Bhangu
- NIHR Global Health Research Unit on Global Surgery, Institute of Applied Health Research, Institute of Translational Medicine, University of Birmingham, Birmingham B15 2TH, UK
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Okeny PK, Pittalis C, Monaghan CF, Brugha R, Gajewski J. Dimensions of patient-centred care from the perspective of patients and healthcare workers in hospital settings in sub-Saharan Africa: A qualitative evidence synthesis. PLoS One 2024; 19:e0299627. [PMID: 38626224 PMCID: PMC11020865 DOI: 10.1371/journal.pone.0299627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 02/14/2024] [Indexed: 04/18/2024] Open
Abstract
INTRODUCTION The United States Institute of Medicine defines patient centred care (PCC), a core element of healthcare quality, as care that is holistic and responsive to individual needs. PCC is associated with better patient satisfaction and improved clinical outcomes. Current conceptualizations of PCC are mainly from Europe and North America. This systematic review summarises the perceived dimensions of PCC among patients and healthcare workers within hospitals in sub-Saharan Africa (SSA). METHODS Without date restrictions, searches were done on databases of the Web of Science, Cochrane Library, PubMed, Embase, Global Health, and grey literature, from their inception up to 11th August 2022. Only qualitative studies exploring dimensions or perceptions of PCC among patients, doctors and/or nurses in hospitals in (SSA) were included. Review articles and editorials were excluded. Two independent reviewers screened titles and abstracts, and conducted full-text reviews with conflicts resolved by a third reviewer. The CASP (critical appraisal skills program) checklist was utilised to assess the quality of included studies. The framework synthesis method was employed for data synthesis. RESULTS 5507 articles were retrieved. Thirty-eight studies met the inclusion criteria, of which 17 were in the specialty of obstetrics, while the rest were spread across different fields. The perceived dimensions reported in the studies included privacy and confidentiality, communication, shared decision making, dignity and respect, continuity of care, access to care, adequate infrastructure and empowerment. Separate analysis of patients' and providers' perspective revealed a difference in the practical understanding of shared-decision making. These dimensions were summarised into a framework consisting of patient-as-person, access to care, and integrated care. CONCLUSION The conceptualization of PCC within SSA was largely similar to findings from other parts of the world, although with a stronger emphasis on access to care. In SSA, both relational and structural aspects of care were significant elements of PCC. Healthcare providers mostly perceived structural aspects such as infrastructure as key dimensions of PCC. TRIAL REGISTRATION PROSPERO Registration number CRD42021238411.
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Affiliation(s)
- Paul K. Okeny
- Institute of Global Surgery, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Department of Surgery, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Chiara Pittalis
- Institute of Global Surgery, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Celina Flocks Monaghan
- Institute of Global Surgery, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Ruairi Brugha
- Institute of Global Surgery, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Jakub Gajewski
- Institute of Global Surgery, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Takoutsing BD, Endalle G, Senyuy WP, Celestin BM, Kwasseu GK, Tanyi PB, Jumbam DT, Kanmounye US. Identifying opportunities for global surgery in Cameroon: an analysis of existing health policies and events. Pan Afr Med J 2024; 47:143. [PMID: 38933430 PMCID: PMC11204985 DOI: 10.11604/pamj.2024.47.143.38399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/18/2024] [Indexed: 06/28/2024] Open
Abstract
Introduction the burden of diseases amenable to surgery, obstetrics, trauma, and anesthesia (SOTA) care is increasing globally but low- and middle-income countries are disproportionately affected. The Lancet Commission on Global Surgery proposed National Surgical, Obstetrics, and Anesthesia Plans as national policies to reduce the global SOTA burden. These plans are dependent on comprehensive stakeholder engagement and health policy analysis. Objective: in this study, we analyzed existing national health policies and events in Cameroon to identify opportunities for SOTA policies. Methods we searched the Cameroonian Ministry of Health´s health policy database to identify past and current policies. Next, the policies were retrieved and screened for mentions of SOTA-related interventions using relevant keywords in French and English, and analyzed using the 'eight-fold path´ framework for public policy analysis. Results we identified 136 policies and events and excluded 16 duplicates. The health policies and events included were implemented between 1967 and 2021. Fifty-nine policies and events (49.2%) mentioned SOTA care: governance (n=25), infrastructure (n=21), service delivery (n=11), workforce (n=11), information management (n=10), and funding (n=8). Most policies and events focused on maternal and neonatal health, followed by anesthesia, ophthalmologic surgery, and trauma. National, multinational civil society organizations and private stakeholders supported these policies and events, and the Cameroonian Ministry of Public Health was the largest funder. Conclusion most Cameroonian SOTA-related policies and events focus on maternal and neonatal care, and health financing is the health system component with the least policies and events. Future SOTA policies should build on existing strengths while improving neglected areas, thus attaining shared global and national goals by 2030.
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Affiliation(s)
- Berjo Dongmo Takoutsing
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Geneviève Endalle
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Wah Praise Senyuy
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Bilong Mbangtang Celestin
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | | | | | - Desmond Tanko Jumbam
- Department of Policy and Advocacy, Operation Smile Ghana, Accra, Greater Accra, Ghana
| | - Ulrick Sidney Kanmounye
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Department of Policy and Advocacy, Operation Smile Ghana, Accra, Greater Accra, Ghana
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Smith ER, Espinoza P, Metcalf M, Ogbuoji O, Cotache-Condor C, Rice HE, Shrime MG. Modeling the global impact of reducing out-of-pocket costs for children's surgical care. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002872. [PMID: 38277421 PMCID: PMC10817198 DOI: 10.1371/journal.pgph.0002872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/09/2024] [Indexed: 01/28/2024]
Abstract
Over 1.7 billion children lack access to surgical care, mostly in low- and middle-income countries (LMICs), with substantial risks of catastrophic health expenditures (CHE) and impoverishment. Increasing interest in reducing out-of-pocket (OOP) expenditures as a tool to reduce the rate of poverty is growing. However, the impact of reducing OOP expenditures on CHE remains poorly understood. The purpose of this study was to estimate the global impact of reducing OOP expenditures for pediatric surgical care on the risk of CHE within and between countries. Our goal was to estimate the impact of reducing OOP expenditures for surgical care in children for 149 countries by modeling the risk of CHE under various scale-up scenarios using publicly available World Bank data. Scenarios included reducing OOP expenditures from baseline levels to paying 70%, 50%, 30%, and 10% of OOP expenditures. We also compared the impact of these reductions across income quintiles (poorest, poor, middle, rich, richest) and differences by country income level (low-income, lower-middle-income, upper-middle-income, and high-income countries).Reducing OOP expenditures benefited people from all countries and income quintiles, although the benefits were not equal. The risk of CHE due to a surgical procedure for children was highest in low-income countries. An unexpected observation was that upper-middle income countries were at higher risk for CHE than LMICs. The most vulnerable regions were Africa and Latin America. Across all countries, the poorest quintile had the greatest risk for CHE. Increasing interest in financial protection programs to reduce OOP expenditures is growing in many areas of global health. Reducing OOP expenditures benefited people from all countries and income quintiles, although the benefits were not equal across countries, wealth groups, or even by wealth groups within countries. Understanding these complexities is critical to develop appropriate policies to minimize the risks of poverty.
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Affiliation(s)
- Emily R. Smith
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Center for Global Surgery and Health Equity, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Pamela Espinoza
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Madeline Metcalf
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Osondu Ogbuoji
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Duke Center for Policy Impact in Global Health, Duke Global Health Institute, Durham, North Carolina, United States of America
- Department of Population Health, Duke School of Medicine, Durham, North Carolina, United States of America
| | - Cesia Cotache-Condor
- Duke Center for Global Surgery and Health Equity, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Henry E. Rice
- Duke Center for Global Surgery and Health Equity, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Mark G. Shrime
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Mercy Ships, Tyler, Texas, United States of America
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Frechette R, Colas N, Augustin M, Edema N, Pyram G, Louis S, Crevecoeur CE, Mathurin C, Louigne R, Patel B, Humphreys M, Chapital A, Martin M, Ayoub Q, Hottinger D, McCurdy MT, Tran Q, Skupski R, Zimmer D, Walsh M. Sustainable surgical resource initiative for Haiti: the SSRI-Haiti project. Glob Health Action 2023; 16:2180867. [PMID: 36856725 PMCID: PMC9980030 DOI: 10.1080/16549716.2023.2180867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
In response to the 2010 earthquake and subsequent cholera epidemic, St Luke's Medical Center was established in Port-au-Prince, Haiti. Here, we describe its inception and evolution to include an intensive care unit and two operating rooms, as well as the staffing, training and experiential learning activities, which helped St Luke's become a sustainable surgical resource. We describe a three-phase model for establishing a sustainable surgical centre in Haiti (build facility and acquire equipment; train staff and perform surgeries; provide continued education and expansion including regular specialist trips) and we report a progressive increase in the number and complexity of cases performed by all-Haitian staff from 2012 to 2022. The results are generalised in the context of the 'delay framework' to global health along with a discussion of the application of this three-phase model to resource-limited environments. We conclude with a brief description of the formation of a remote surgical centre in Port-Salut, an unforeseen benefit of local competence and independence. Establishing sustainable and collaborative surgery centres operated by local staff accelerates the ability of resource-limited countries to meet high surgical burdens.
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Affiliation(s)
- Richard Frechette
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Nathalie Colas
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Marc Augustin
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Nathalie Edema
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Gerson Pyram
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Stanley Louis
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Carl Eric Crevecoeur
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Carmeline Mathurin
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Raphael Louigne
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Bhavesh Patel
- Departments of Critical Care Medicine, Urology and Surgery, Mayo Clinic and Global, Surgical, Destination, Healthcare Inc., Phoenix, AZ, USA
| | - Mitchell Humphreys
- Departments of Critical Care Medicine, Urology and Surgery, Mayo Clinic and Global, Surgical, Destination, Healthcare Inc., Phoenix, AZ, USA
| | - Alyssa Chapital
- Departments of Critical Care Medicine, Urology and Surgery, Mayo Clinic and Global, Surgical, Destination, Healthcare Inc., Phoenix, AZ, USA
| | - Mallory Martin
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Qamarissa Ayoub
- Bamiyan Maternal and Child Health Project and the Andeshgah Library, Kabul, Afghanistan
| | - Daniel Hottinger
- Department of Anesthesia, Metropolitan Anesthesia Network, LLP, Plymouth, MN, USA
| | - Michael T McCurdy
- Division of Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Quincy Tran
- Division of Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Richard Skupski
- Department of Medical Education, University of Indiana School of Medicine, South Bend/Notre Dame Campus, South Bend, IN, USA.,Department of Anesthesia, Memorial Hospital Beacon Medical Group of South Bend, South Bend, IN, USA
| | - Donald Zimmer
- Department of Medical Education, University of Indiana School of Medicine, South Bend/Notre Dame Campus, South Bend, IN, USA.,Department of Emergency Medicine, Memorial Hospital Beacon Medical Group of South Bend, South Bend, IN, USA
| | - Mark Walsh
- Department of Medical Education, University of Indiana School of Medicine, South Bend/Notre Dame Campus, South Bend, IN, USA.,Departments of Emergency and Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, USA
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8
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Bekele A, Alayande BT, Powell BL, Obi N, Seyi-Olajide JO, Riviello RR, Ntirenganya F, Ameh EA, Makasa EM. National Surgical Healthcare Policy Development and Implementation: Where do We Stand in Africa? World J Surg 2023; 47:3020-3029. [PMID: 37550548 DOI: 10.1007/s00268-023-07131-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND National surgical policies have been increasingly adopted by African countries over the past decade. This report is intended to provide an overview of the current state of adoption of national surgical healthcare policies in Africa, and to draw a variety of lessons from representative surgical plans in order to support transnational learning. METHODS Through a desk review of available African national surgical healthcare plans and written contributions from a committee comprising six African surgical policy development experts, a few key lessons from five healthcare plans were outlined and iteratively reviewed. RESULTS The current state of national surgical healthcare policies across Africa was visually mapped, and lessons from a few compelling examples are highlighted. These include the power of initiative from Senegal; regional leadership from Zambia; contextualization, and renewal of commitment from Ethiopia; multidisciplinary focus and creation of multiple implementation entry points from Nigeria; partnerships and involvement of multiple stakeholders from Rwanda; and the challenge of surgical policy financing from Tanzania. The availability of global expertise, the power of global partnerships, and the critical role of health ministries and Ministers of Health in planning and implementation have also been highlighted. CONCLUSIONS Strategic planning for surgical healthcare improvement is at various stages across the continent, with potential for countries to learn from one another. Convenings of stakeholders and Ministers of Health from countries at various stages of strategic surgical plan development, execution, and evaluation can enhance African surgical policy development through the exchange of ideas, lessons, and experiences.
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Affiliation(s)
- Abebe Bekele
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Ave., 5Th Floor, PO Box 6955, Kigali, Rwanda
| | - Barnabas Tobi Alayande
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Ave., 5Th Floor, PO Box 6955, Kigali, Rwanda.
- Harvard TH Chan School of Public Health, Boston, MA, USA.
| | - Britany L Powell
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Ave., 5Th Floor, PO Box 6955, Kigali, Rwanda
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | - Robert R Riviello
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Ave., 5Th Floor, PO Box 6955, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | | | - Emmanuel A Ameh
- Department of Surgery, National Hospital, Central Business District, Abuja, Nigeria
| | - Emmanuel M Makasa
- Wits Centre of Surgical Care for Primary Health and Sustainable Development, University of the Witwatersrand, Johannesburg, South Africa
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Khan IA, Karim HMR. Anesthesia Services in Low- and Middle-Income Countries: The Fragile Point for Safe Surgery and Patient Safety. Cureus 2023; 15:e43174. [PMID: 37692747 PMCID: PMC10484723 DOI: 10.7759/cureus.43174] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/12/2023] Open
Abstract
The Safe Surgery Saves Life campaign of the World Health Organization advocates patient safety best practices during surgical procedures. Anesthesia service is indivisible from the patient safety best practices. Although anesthesia services are safer than ever before, safe delivery of anesthesia service and patient safety depends significantly on the availability of qualified anesthesiologists, the knowledge and competency of anesthesiologists, the work environment, and the availability of essential equipment and monitoring facilities. Despite anesthesiologists being the midstream of perioperative care, their role and service are often underacknowledged, especially in low- and middle-income countries (LMICs). Anesthesia services in LMICs face myriad challenges such as a shortage of skilled personnel, inadequate resources, limited training opportunities, and minimal administrative say, which act as the fragile point in the chain of safe surgery delivery. Specific solutions should focus on strengthening the anesthesia workforce, providing fair remuneration and incentives, advocating for anesthesia autonomy, and facilitating access to educational resources. Nevertheless, managing these problems requires a collaborative effort involving governments, healthcare organizations, and international stakeholders to develop sustainable solutions and prioritize the well-being of both anesthesia providers and patients. This editorial focuses on it briefly, emphasizing the anesthesia of rural healthcare service and patient safety.
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Affiliation(s)
- Imran A Khan
- Community and Family Medicine, Baba Raghav Das Medical College, Gorakhpur, IND
| | - Habib Md R Karim
- Anesthesiology, Critical Care, and Pain Medicine, All India Institute of Medical Sciences, Deoghar, Deoghar, IND
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10
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Qin RX, Yoon S, Fowler ZG, Jayaram A, Stankey M, Samad L, Maoate K, Park KB. Financing surgical, obstetric, anaesthesia, and trauma care in the Asia-Pacific region: proceedings. BMC Proc 2023; 17:10. [PMID: 37488559 PMCID: PMC10367232 DOI: 10.1186/s12919-023-00256-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
Surgical, obstetric, and anaesthesia care saves lives, prevents disability, promotes economic prosperity, and is a fundamental human right. Session two of the three-part virtual meeting series on Strategic Planning to Improve Surgical, Obstetric, Anaesthesia, and Trauma Care in the Asia-Pacific Region discussed financing strategies for surgical care. During this session, participants made a robust case for investing in surgical care given its cost-effectiveness, macroeconomic benefits, and contribution to health security and pandemic preparedness. Funding for surgical system strengthening could arise from both domestic and international sources. Numerous strategies are available for mobilising funding for surgical care, including conducive macroeconomic growth, reprioritisation of health within government budgets, sector-specific domestic revenue, international financing, improving the effectiveness and efficiency of health budgets, and innovative financing. A wide range of funders recognised the importance of investing in surgical care and shared their currently funded projects in surgical, obstetric, anaesthesia, and trauma care as well as their funding priorities. Advocacy efforts to mobilise funding for surgical care to align with the existing funder priorities, such as primary health care, maternal and child health, health security, and the COVID-19 pandemic. Although the COVID-19 pandemic has constricted the fiscal space for surgical care, it has also brought unprecedented attention to health. Short-term investment in critical care, medical oxygen, and infection prevention and control as a part of the COVID-19 response must be leveraged to generate sustained strengthening of surgical systems beyond the pandemic.
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Affiliation(s)
- Rennie X Qin
- The Program in Global Surgery and Social Change, the Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, USA
| | - Sangchul Yoon
- The Program in Global Surgery and Social Change, the Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, USA.
- Department of Medical Humanities and Social Sciences, College of Medicine, Yonsei University, Seoul, South Korea.
| | - Zachary G Fowler
- The Program in Global Surgery and Social Change, the Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, USA
| | - Anusha Jayaram
- The Program in Global Surgery and Social Change, the Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, USA
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA, 02111, USA
| | - Makela Stankey
- The Program in Global Surgery and Social Change, the Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, USA
- Keck School of Medicine at the University of Southern California, 1975 Zonal Ave, Los Angeles, CA, 90033, USA
| | - Lubna Samad
- Interactive Research and Development (IRD), 4Th Floor, Woodcraft Building, Plot 3 & 3 A Sector 47, Korangi Creek Road, Karachi, Pakistan
| | - Kiki Maoate
- Department of Surgery, University of Otago, 2 Riccarton Avenue, Christchurch Central City, Christchurch, 8011, New Zealand
| | - Kee B Park
- The Program in Global Surgery and Social Change, the Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, USA
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11
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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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12
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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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13
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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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14
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Hu Y, Tong Z, Huang X, Qin JJ, Lin L, Lei F, Wang W, Liu W, Sun T, Cai J, She ZG, Li H. The projections of global and regional rheumatic heart disease burden from 2020 to 2030. Front Cardiovasc Med 2022; 9:941917. [PMID: 36330016 PMCID: PMC9622772 DOI: 10.3389/fcvm.2022.941917] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background Rheumatic heart disease (RHD) remains the leading cause of preventable death and disability in children and young adults, killing an estimated 320,000 individuals worldwide yearly. Materials and methods We utilized the Bayesian age-period cohort (BAPC) model to project the change in disease burden from 2020 to 2030 using the data from the Global Burden of Disease (GBD) Study 2019. Then we described the projected epidemiological characteristics of RHD by region, sex, and age. Results The global age-standardized prevalence rate (ASPR) and age-standardized incidence rate (ASIR) of RHD increased from 1990 to 2019, and ASPR will increase to 559.88 per 100,000 population by 2030. The global age-standardized mortality rate (ASMR) of RHD will continue declining, while the projected death cases will increase. Furthermore, ASPR and cases of RHD-associated HF will continue rising, and there will be 2,922,840 heart failure (HF) cases in 2030 globally. Female subjects will still be the dominant population compared to male subjects, and the ASPR of RHD and the ASPR of RHD-associated HF in female subjects will continue to increase from 2020 to 2030. Young people will have the highest ASPR of RHD among all age groups globally, while the elderly will bear a greater death and HF burden. Conclusion In the following decade, the RHD burden will remain severe. There are large variations in the trend of RHD burden by region, sex, and age. Targeted and effective strategies are needed for the management of RHD, particularly in female subjects and young people in developing regions.
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Affiliation(s)
- Yingying Hu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Model Animal, Wuhan University, Wuhan, China
| | - Zijia Tong
- Department of Cardiology, Huanggang Central Hospital of Yangtze University, Huanggang, China
- Huanggang Institute of Translational Medicine, Huanggang, China
| | - Xuewei Huang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Model Animal, Wuhan University, Wuhan, China
| | - Juan-Juan Qin
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Model Animal, Wuhan University, Wuhan, China
| | - Lijin Lin
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Model Animal, Wuhan University, Wuhan, China
| | - Fang Lei
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Model Animal, Wuhan University, Wuhan, China
| | - Wenxin Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Model Animal, Wuhan University, Wuhan, China
| | - Weifang Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Model Animal, Wuhan University, Wuhan, China
| | - Tao Sun
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Model Animal, Wuhan University, Wuhan, China
| | - Jingjing Cai
- Institute of Model Animal, Wuhan University, Wuhan, China
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhi-Gang She
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Model Animal, Wuhan University, Wuhan, China
- *Correspondence: Hongliang Li,
| | - Hongliang Li
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Model Animal, Wuhan University, Wuhan, China
- Zhi-Gang She,
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15
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Landrum KR, Hall BJ, Smith ER, Flores W, Lou-Meda R, Rice HE. Challenges with pediatric surgical financing and universal health coverage in Guatemala: A qualitative analysis. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000220. [PMID: 36962482 PMCID: PMC10021280 DOI: 10.1371/journal.pgph.0000220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 08/21/2022] [Indexed: 06/18/2023]
Abstract
The financing of surgical care for children in low- and middle-income countries (LMICs) remains challenging and may restrict adherence to universal health coverage (UHC) frameworks. Our aims were to describe Guatemala's national pediatric surgical financing structure, to identify financing challenges, and to develop recommendations to improve the financing of surgical care for children. We conducted a qualitative study of the financing of surgical care for children in Guatemala's public health system with key informant interviews (n = 20) with experts in the medical, financial, and political health sectors. We used this data to generate recommendations to improve surgical care financing for children. We identified several systemic challenges to the financing of surgical care for children, including passive purchasing structures, complex political contexts, health system fragmentation, widespread use of informal fees for surgical services, and lack of earmarked funding for surgical care. Patient and provider challenges include lack of provider input in non-personnel funding decisions, and patients functioning as both financing agents and beneficiaries in the same financing stream. Key recommendations include reducing health finance system fragmentation through resource pooling, increasing earmarked funding for surgical care with quantifiable outcome measures, engagement with clinical providers in non-personnel budgetary decision-making, and use of innovative financing instruments such as resource pooling. Surgical financing for children in Guatemala requires substantial remodeling to increase access to timely, affordable, and safe surgical care and improve alignment with Guatemala's UHC scheme.
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Affiliation(s)
- Kelsey R. Landrum
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Bria J. Hall
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Emily R. Smith
- Duke Global Health Institute, Durham, North Carolina, United States of America
- Robbins College of Health and Human Sciences, Baylor University, Waco, Texas, United States of America
| | - Walter Flores
- Centro De Estudios Para La Equidad y Gobernanza En Los Sistema De Salud, Guatemala City, Guatemala
| | - Randall Lou-Meda
- Department of Pediatrics, Roosevelt Hospital, Guatemala City, Guatemala
| | - Henry E. Rice
- Duke Global Health Institute, Durham, North Carolina, United States of America
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
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16
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Fowler Z, Dutta R, Kilgallon JL, Wobenjo A, Bandyopadhyay S, Shah P, Jain S, Raykar NP, Roy N. Academic Output in Global Surgery after the Lancet Commission on Global Surgery: A Scoping Review. World J Surg 2022; 46:2317-2325. [PMID: 35849172 PMCID: PMC9436886 DOI: 10.1007/s00268-022-06640-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2022] [Indexed: 11/30/2022]
Abstract
Background The Lancet Commission on Global Surgery (LCoGS) published its seminal report in 2015, carving a niche for global surgery academia. Six years after the LCoGS, a scoping review was conducted to see how the term 'global surgery' is characterized by the literature and how it relates to LCoGS and its domains. Methods PubMed was searched for publications between January 2015 and February 2021 that used the term ‘global surgery’ in the title, abstract, or key words or cited the LCoGS. Variables extracted included LCoGS domains, authorship metrics, geographic scope, and clinical specialty. Results The search captured 938 articles that qualified for data extraction. Nearly 80% of first and last authors had high-income country affiliations. Africa was the most frequently investigated region, though many countries within the region were under-represented. The World Journal of Surgery was the most frequent journal, publishing 13.9% of all articles. General surgery, pediatric surgery, and neurosurgery were the most represented specialties. Of the LCoGS domains, healthcare delivery and management were the most studied, while economics and financing were the least studied. Conclusion A lack of consensus on the definition of global surgery remains. Additional research is needed in economics and financing, while obstetrics and trauma are under-represented in literature using the term ‘global surgery’. Efforts in academic global surgery must give a voice to those carrying the global surgery agenda forward on the frontlines. Focusing on research capacity-building and encouraging contribution by local partners will lead to a stronger, more cohesive global surgery community. Supplementary Information The online version contains supplementary material available at 10.1007/s00268-022-06640-8.
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Affiliation(s)
- Zachary Fowler
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Rohini Dutta
- Christian Medical College and Hospital, Ludhiana, Punjab, India
- WHO Collaborating Centre for Research in Surgical Care Delivery in Low-Middle-Income Countries, Mumbai, India
| | - John L Kilgallon
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Adili Wobenjo
- WHO Collaborating Centre for Research in Surgical Care Delivery in Low-Middle-Income Countries, Mumbai, India
- Department of Surgery, Kenyatta University, Nairobi, Kenya
| | - Soham Bandyopadhyay
- Nuffield Department of Surgical Sciences, Oxford University Global Surgery Group, University of Oxford, Oxford, UK
- Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Samarvir Jain
- WHO Collaborating Centre for Research in Surgical Care Delivery in Low-Middle-Income Countries, Mumbai, India
- Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Nakul P Raykar
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
- Division of Trauma, Emergency Surgery, Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nobhojit Roy
- WHO Collaborating Centre for Research in Surgical Care Delivery in Low-Middle-Income Countries, Mumbai, India.
- Department of Public Health Systems, Karolinska Institute, 171 77, Stockholm, Sweden.
- The George Institute of Global Health, New Delhi, India.
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17
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Sharma D, Cotton M. A call for greater public involvement in public health. Trop Doct 2022; 52:373-374. [PMID: 36083594 DOI: 10.1177/00494755221111685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Michael Cotton
- Professor, Government NSCB Medical College, Jabalpur, India 482003
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18
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Corbally MT. The role of registered charities in the delivery of global surgery in low- and middle-income countries - a personal experience. Surgeon 2021; 20:41-47. [PMID: 34930698 DOI: 10.1016/j.surge.2021.11.001] [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: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Abstract
The world's resources are unequally divided. Investment in healthcare in Low- and Middle-Income Countries (LMICs) has traditionally involved vertical public health strategies with little emphasis on the delivery of safe and effective surgery and anesthesia. The past 20 years has witnessed greater awareness of the numbers of people who have no access to surgery, the morbidity and mortality of such limited access, and the cost to the individual and society if a solution is not found. Global surgery has become a hot topic and The Millennium Development Goals (MDG) and the Sustainable Development Goals (SDG) have underlined the importance of surgery in national health care plans. The harsh metrics reported by the Lancet Commission has framed the problem in more concrete terms and as of today, over 5 billion people lack access to safe surgery, over 143 million extra surgeries are needed annually to affect the imbalance and more than 15,000 children die each day in Sub Saharan Africa and Southeast Asia from preventable disease, including the lack of access to safe surgery. Horizontal integrated healthcare that includes surgical provision is the new norm, but its introduction is expensive and will need time. The ambition of universal healthcare access for all people (SDG) with a corresponding reduction in child and maternal mortality will be difficult for most governments. Altruistic, Non-Governmental Organizations (NGOs) are ideally placed to assist this goal but must introduce changes in practice to include onsite and off-site training, broad partnerships with other NGOs and academic bodies and greater advocacy with governments to ensure sustainability. NGOs should work in concert with local agencies, hospitals and governments to meet local needs.
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Affiliation(s)
- Martin T Corbally
- Royal College of Surgeons - Medical University Bahrain, King Hamad University Hospital, Kingdom of Bahrain.
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19
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Fleming KA, Horton S, Wilson ML, Atun R, DeStigter K, Flanigan J, Sayed S, Adam P, Aguilar B, Andronikou S, Boehme C, Cherniak W, Cheung AN, Dahn B, Donoso-Bach L, Douglas T, Garcia P, Hussain S, Iyer HS, Kohli M, Labrique AB, Looi LM, Meara JG, Nkengasong J, Pai M, Pool KL, Ramaiya K, Schroeder L, Shah D, Sullivan R, Tan BS, Walia K. The Lancet Commission on diagnostics: transforming access to diagnostics. Lancet 2021; 398:1997-2050. [PMID: 34626542 PMCID: PMC8494468 DOI: 10.1016/s0140-6736(21)00673-5] [Citation(s) in RCA: 136] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/26/2021] [Accepted: 03/12/2021] [Indexed: 12/30/2022]
Affiliation(s)
| | - Susan Horton
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.
| | | | - Rifat Atun
- Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | | | | | | | - Bertha Aguilar
- Médicos e Investigadores de la Lucha Contra el Cáncer de Mama, Mexico City, Mexico
| | - Savvas Andronikou
- Perelman School of Medicine, University of Pennsylvania Philadelphia, Philadelphia, PA, USA
| | | | - William Cherniak
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Annie Ny Cheung
- The University of Hong Kong, Hong Kong Special Administrative Region, China
| | | | - Lluis Donoso-Bach
- Department of Medical Imaging, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | | | | | - Sarwat Hussain
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Hari S Iyer
- Dana Farber Cancer Institute, Boston, MA, USA
| | - Mikashmi Kohli
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Alain B Labrique
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - John Nkengasong
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Madhukar Pai
- School of Population and Global Health, McGill University, Montreal, QC, Canada
| | | | | | - Lee Schroeder
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Devanshi Shah
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | | | | | - Kamini Walia
- Indian Council of Medical Research, Delhi, India
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20
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Ifeanyichi M, Aune E, Shrime M, Gajewski J, Pittalis C, Kachimba J, Borgstein E, Brugha R, Baltussen R, Bijlmakers L. Financing of surgery and anaesthesia in sub-Saharan Africa: a scoping review. BMJ Open 2021; 11:e051617. [PMID: 34667008 PMCID: PMC8527159 DOI: 10.1136/bmjopen-2021-051617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study aimed to provide an overview of current knowledge and situational analysis of financing of surgery and anaesthesia across sub-Saharan Africa (SSA). SETTING Surgical and anaesthesia services across all levels of care-primary, secondary and tertiary. DESIGN We performed a scoping review of scientific databases (PubMed, EMBASE, Global Health and African Index Medicus), grey literature and websites of development organisations. Screening and data extraction were conducted by two independent reviewers and abstracted data were summarised using thematic narrative synthesis per the financing domains: mobilisation, pooling and purchasing. RESULTS The search resulted in 5533 unique articles among which 149 met the inclusion criteria: 132 were related to mobilisation, 17 to pooling and 5 to purchasing. Neglect of surgery in national health priorities is widespread in SSA, and no report was found on national level surgical expenditures or budgetary allocations. Financial protection mechanisms are weak or non-existent; poor patients often forego care or face financial catastrophes in seeking care, even in the context of universal public financing (free care) initiatives. CONCLUSION Financing of surgical and anaesthesia care in SSA is as poor as it is underinvestigated, calling for increased national prioritisation and tracking of surgical funding. Improving availability, accessibility and affordability of surgical and anaesthesia care require comprehensive and inclusive policy formulations.
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Affiliation(s)
- Martilord Ifeanyichi
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
- EMAI Health Systems and Health Services Consulting, Nijmegen, The Netherlands
| | - Ellis Aune
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Mark Shrime
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jakub Gajewski
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Chiara Pittalis
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - John Kachimba
- Department of Surgery, University of Zambia University Teaching Hospital, Lusaka, Zambia
| | - Eric Borgstein
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Ruairi Brugha
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Rob Baltussen
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Leon Bijlmakers
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
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21
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Ifeanyichi M, Gajewski J, Baltussen R, Borgstein E, Kachimba J, Brugha R, Bijlmakers L. COVID-19 pandemic: Revisiting the case for a dedicated financing mechanism for surgical care in resource-poor countries. J Glob Health 2021; 11:03090. [PMID: 34386211 PMCID: PMC8325879 DOI: 10.7189/jogh.11.03090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Martilord Ifeanyichi
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands.,EMAI Health Systems and Health Services Consulting, Nijmegen, the Netherlands
| | - Jakub Gajewski
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Rob Baltussen
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Eric Borgstein
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - John Kachimba
- Surgical Society of Zambia, Department of Surgery, University Teaching Hospital, Lusaka, Zambia
| | - Ruairi Brugha
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Leon Bijlmakers
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
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22
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Hricak H, Abdel-Wahab M, Atun R, Lette MM, Paez D, Brink JA, Donoso-Bach L, Frija G, Hierath M, Holmberg O, Khong PL, Lewis JS, McGinty G, Oyen WJG, Shulman LN, Ward ZJ, Scott AM. Medical imaging and nuclear medicine: a Lancet Oncology Commission. Lancet Oncol 2021; 22:e136-e172. [PMID: 33676609 PMCID: PMC8444235 DOI: 10.1016/s1470-2045(20)30751-8] [Citation(s) in RCA: 120] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 12/13/2022]
Abstract
The diagnosis and treatment of patients with cancer requires access to imaging to ensure accurate management decisions and optimal outcomes. Our global assessment of imaging and nuclear medicine resources identified substantial shortages in equipment and workforce, particularly in low-income and middle-income countries (LMICs). A microsimulation model of 11 cancers showed that the scale-up of imaging would avert 3·2% (2·46 million) of all 76·0 million deaths caused by the modelled cancers worldwide between 2020 and 2030, saving 54·92 million life-years. A comprehensive scale-up of imaging, treatment, and care quality would avert 9·55 million (12·5%) of all cancer deaths caused by the modelled cancers worldwide, saving 232·30 million life-years. Scale-up of imaging would cost US$6·84 billion in 2020-30 but yield lifetime productivity gains of $1·23 trillion worldwide, a net return of $179·19 per $1 invested. Combining the scale-up of imaging, treatment, and quality of care would provide a net benefit of $2·66 trillion and a net return of $12·43 per $1 invested. With the use of a conservative approach regarding human capital, the scale-up of imaging alone would provide a net benefit of $209·46 billion and net return of $31·61 per $1 invested. With comprehensive scale-up, the worldwide net benefit using the human capital approach is $340·42 billion and the return per dollar invested is $2·46. These improved health and economic outcomes hold true across all geographical regions. We propose actions and investments that would enhance access to imaging equipment, workforce capacity, digital technology, radiopharmaceuticals, and research and training programmes in LMICs, to produce massive health and economic benefits and reduce the burden of cancer globally.
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Affiliation(s)
- Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Radiology, Weill Cornell Medical College, New York, NY, USA.
| | - May Abdel-Wahab
- International Atomic Energy Agency, Division of Human Health, Vienna, Austria; Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt; Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Rifat Atun
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
| | | | - Diana Paez
- International Atomic Energy Agency, Division of Human Health, Vienna, Austria
| | - James A Brink
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Lluís Donoso-Bach
- Department of Medical Imaging, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | | | | | - Ola Holmberg
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
| | - Pek-Lan Khong
- Department of Diagnostic Radiology, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jason S Lewis
- Department of Radiology and Molecular Pharmacology Programme, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Departments of Pharmacology and Radiology, Weill Cornell Medical College, New York, NY, USA
| | - Geraldine McGinty
- Departments of Radiology and Population Science, Weill Cornell Medical College, New York, NY, USA; American College of Radiology, Reston, VA, USA
| | - Wim J G Oyen
- Department of Biomedical Sciences and Humanitas Clinical and Research Centre, Department of Nuclear Medicine, Humanitas University, Milan, Italy; Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, Netherlands; Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Lawrence N Shulman
- Department of Medicine, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Zachary J Ward
- Center for Health Decision Science, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Andrew M Scott
- Tumour Targeting Laboratory, Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia; Department of Molecular Imaging and Therapy, Austin Health, Melbourne, VIC, Australia; School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia; Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
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23
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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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24
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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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