3 research outputs found
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Assessing the Brazilian surgical system with six surgical indicators: a descriptive and modelling study
Background: Brazil boasts a health scheme that aspires to provide universal coverage, but its surgical system has rarely been analyzed. In an effort to strengthen surgical systems worldwide, the Lancet Commission on Global Surgery proposed collection of six standardized indicators: two-hour access to surgery, surgical workforce density, surgical volume, perioperative mortality rate (POMR), and protection against impoverishing and catastrophic expenditure. This study aims to characterize the Brazilian surgical health system with these newly devised indicators while gaining understanding on the complexity of the indicators themselves.
Methods: Using Brazil鈥檚 national healthcare database, commonly reported healthcare variables were used to calculate or simulate the six surgical indicators. Access to surgery was calculated using hospital locations, surgical workforce density was calculated using locations of surgeons, anesthesiologists and obstetricians (SAO), and surgical volume and POMR were identified with surgical procedure codes. The rates of protection against impoverishing and catastrophic expenditure were modelled using cost of inpatient hospitalization and a gamma distribution of incomes based on GINI and GDP/capita.
Findings: In 2014, SAO density is 34路7/100,000 population, surgical volume is 4,433 procedures/100,000 people and POMR is 1路71%. 79路4% of surgical patients are protected against impoverishing expenditure and 84路6% were protected against catastrophic expenditure due to surgery each year. Two-hour access to surgery was not able to be calculated from national health data, but a proxy measure suggested that 97路2% of the population has two-hour access to a hospital that may be able to provide surgery. Geographic disparities were seen in all indicators.
Interpretation: Brazil鈥榮 public surgical system meets several key benchmarks. Geographic disparities, however, are substantial and raise concerns of equity. Policies should focus on stimulating appropriate geographic allocation of the surgical workforce. In some cases, where benchmarks for each indicator are met, supplemental analysis can further inform our understanding of health systems. This measured and systematic evaluation of surgical systems should be encouraged for all nations seeking to better understand their surgical systems.
Funding: There was no funding for this study
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Access to safe blood in low-income and middle-income countries: lessons from India
Timely, affordable access to screened blood is essential to the provision of safe surgical care, and depends on three key aspects: adequate volume of blood supply, safe protocols for blood donation and transfusion, and appropriate regulation to ensure safe, equitable, and sustainable distribution. Many low- and middle-income countries experience a deficit in these categories, particularly in rural areas. We draw on the experience of rural surgical practitioners in India and summarize the existing literature to evaluate India鈥檚 blood banking system and discuss its major barriers to the safe and equitable provision of blood.
Many low- and middle-income countries struggle with accruing a sufficient voluntary, unpaid blood donation base to meet the need. Efforts to increase blood supply through mandatory family replacement donations can lead to dangerous delays in care provision. Additionally, prohibition of unbanked, directed blood transfusion restricts the options of health practitioners, particularly in rural areas. Blood safety is also a significant concern, and efforts must be taken to decrease the risk of transfusion-transmitted infections and inform and treat donors who test positive. Lastly, blood banking systems need a centralized governing body to ensure fair prices for blood, promote comprehensive transfusion reporting, and increase system-wide transparency and accountability
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Using the Consolidated Framework for Implementation Research to implement and evaluate national surgical planning
The Lancet Commission on Global Surgery defined six surgical indicators and a framework for a National Surgical Plan that aimed to incorporate surgical care as a part of global public health. Multiple countries have since begun national surgical planning; each face unique challenges in doing so. Implementation science can be utilized to more systematically explain this heterogeneous process, guide implementation efforts, and ultimately evaluate progress. We describe our intervention using the Consolidated Framework for Implementation Research. This framework requires identifying characteristics of the intervention, the individuals involved, the inner and outer setting of the intervention and, finally, describing implementation processes. By hosting a consultative symposium with clinicians and policy makers from around the world, we are able to specify key aspects of each element of this framework. We define our intervention as the incorporation of surgical care into public health planning, identify local champions as the key individuals involved, and describe elements of the inner and outer setting. Ultimately we describe a top-down and bottom-up model that are distinct implementation processes. With the Consolidated Framework for Implementation Research we are able to identify specific strategic models that can be used by implementers in various settings. While the integration of surgical care into public health throughout the world may seem like an insurmountable challenge, this work adds to a growing effort that seeks to find a way forward