A country-level comparison of access to quality surgical and non-surgical healthcare from 1990-2016

BACKGROUND: The Healthcare Access and Quality (HAQ) index, developed by the Institute for Health Metrics and Evaluation, uses estimates of amenable mortality to quantify health system performance over time. While much is known about general health system performance globally, few studies have portrayed the performance of surgical systems. In order to quantify access to quality surgical care, evaluate changes over time, and link these changes to health care investments, surgical and non-surgical Health Access and Quality sub-indices were developed. DESIGN: We categorized 32 amenable mortality causes as either surgical or non-surgical conditions. Using principal components analysis and scaled amenable mortality rates, we constructed a surgical and non-surgical Health Access and Quality sub-index. Using these sub-indices, relative improvement over time was compared. An expenditure model with country fixed effects was built to explore drivers of differences in relative improvement of sub-indices. RESULTS: Compared to low-income countries, high-income countries have been 2.77 times more effective at improving surgical care (p < .05). Government expenditure on healthcare has a larger effect on improving surgical Health Access and Quality (p < 0.05) while development assistance for health has a larger effect on improving non-surgical Health Access and Quality (p < 0.05). CONCLUSIONS AND RELEVANCE: Global health investment must prioritize strengthening health systems as opposed to the historically favored vertical programming. In order to achieve health equity in low-income countries, more focus should be placed on domestic financing of surgical systems. Health Access and Quality sub-indices can be used by countries to identify targets, monitor progress, and evaluate interventions aimed at improving access to quality surgical healthcare

Towards resilient health systems: opportunities to align surgical and disaster planning

Natural disasters significantly contribute to human death and suffering. Moreover, they exacerbate pre-existing health inequalities by imposing an additional burden on the most vulnerable populations. Robust local health systems can greatly mitigate this burden by absorbing the extraordinary patient volume and case complexity immediately after a disaster. This resilience is largely determined by the predisaster local surgical capacity, with trauma, neurosurgical, obstetrical and anaesthesia care of particular importance. Nevertheless, the disaster management and global surgery communities have not coordinated the development of surgical systems in low/middle-income countries (LMIC) with disaster resilience in mind. Herein, we argue that an appropriate peridisaster response requires coordinated surgical and disaster policy, as only local surgical systems can provide adequate disaster care in LMICs. We highlight three opportunities to help guide this policy collaboration. First, the Lancet Commission on Global Surgery and the Sendai Framework for Disaster Risk Reduction set forth independent roadmaps for global surgical care and disaster risk reduction; however, ultimately both advocate for health system strengthening in LMICs. Second, the integration of surgical and disaster planning is necessary. Disaster risk reduction plans could recognise the role of surgical systems in disaster preparedness more explicitly and pre-emptively identify deficiencies in surgical systems. Based on these insights, National Surgical, Obstetric, and Anesthesia Plans, in turn, can better address deficiencies in systems and ensure increased disaster resilience. Lastly, the recent momentum for national surgical planning in LMICs represents a political window for the integration of surgical policy and disaster risk reduction strategies

Globalization of national surgical, obstetric and anesthesia plans: the critical link between health policy and action in global surgery

Efforts from the developed world to improve surgical, anesthesia and obstetric care in low- and middle-income countries have evolved from a primarily volunteer mission trip model to a sustainable health system strengthening approach as private and public stakeholders recognize the enormous health toll and financial burden of surgical disease. The National Surgical, Obstetric and Anesthesia Plan (NSOAP) has been developed as a policy strategy for countries to address, in part, the health burden of diseases amenable to surgical care, but these plans have not developed in isolation. The NSOAP has become a phenomenon of globalization as a broad range of partners - individuals and institutions - help in both NSOAP formulation, implementation and financing. As the nexus between policy and action in the field of global surgery, the NSOAP reflects a special commitment by state actors to make progress on global goals such as Universal Health Coverage and the United Nations Sustainable Development Goals. This requires a continued global commitment involving genuine partnerships that embrace the collective strengths of both national and global actors to deliver sustained, safe and affordable high-quality surgical care for all poor, rural and marginalized people

Impact 2003

Index Competitive Agricultural Systems in a Global Economy Biosecurity Education .................................................. 1 Calf Scours Prevention System .................................................. 2 Center for Agricultural & Food Industrial Organization .................................................. 3 Chickpeas as an Alternative Crop .................................................. 5 .................................................. 6 Dry Ethanol Byproducts for Farms and Ranches .................................................. 7 Indoor Prawn Production .................................................. 8 National Drought Mitigation Center .................................................. 9 Republican River Basin Irrigation Management Project .................................................. 11 Small Farm and Ranch Profitability Project .................................................. 12 Sorting and Mixing Pigs .................................................. 14 WeedSOFT Aids Weed Management Decisions ....................................15 New Beef Products Add Value* ....................................16 Panhandle Chicory Production* ....................................18 Ranch Practicum* .................................... 19 Turf Grass Seed Production* .................................... 20 Safe and Secure Food and Fiber Systems Biosecurity Education ................................................ 21 E. coli Research .................................... 22 Testing Oil Freshness .................................... 24 Healthy, Well-Nourished Population Food Safety and Nutrition Web Site ....................................25 Improving Young Adults\u27 Eating Habits ....................................26 Nutrition Education Programs* ....................................27 Smoking and Diet* .................................... 28 Sun-Protective Clothing Standards* ....................................29 Greater Harmony Between Agriculture and the Environment Buffer Strip Assessment Tool .................................... 30 Irrigation Management Home Study Course .......................................................................................... 31 Livestock and Poultry Environmental Stewardship Curriculum ........................................................ 32 Monitoring Lake Water Quality ....................................33 Nitrogen Management in Crop Production ............................................................................................. 34 Republican River Basin Irrigation Management Project ....................................35 Rootworm Resistance Research ....................................36 WeedSOFT Aids Weed Management Decisions ....................................37 Cleaning Up Pesticide-Contaminated Soil* ....................................38 Measuring Carbon Storage in Cropland* ....................................40 Pivots, Nitrogen Management Protect Water Quality* .............................................. 41 Reducing Livestock Methane* ....................................42 Economic Development and Quality of Life for People and Communities Bridging the Technology Gap ....................................43 Consumer Preference and Economic Leakage Study Program ....................................44 Decorative Millet Earns All-America Selections. Gold ....................................45 Distance Counseling Improves Access for Rural Residents ................................................................. 46 Drought Web Site .................................... 47 Forensic Entomology .................................... 48 National Drought Mitigation Center ....................................49 Nebraska Rural Poll Provides Rural Perspective ....................................51 Protecting Water Quality Along the Lower Platte River ........................................................................ 53 Rural Women\u27s Concerns .................................... 54 Small Farm and Ranch Profitability Project ............................................................................................. 55 Technical Assistance for Geothermal Systems ........................................................................................ 57 Building Nebraska Families* .................................... 58 Coping with Divorce* .................................... 59 Food Processing Center Entrepreneurship Services* ............................................................................. 60 Giving Entrepreneurs an EDGE* ....................................61 Meat Plants Changing Rural Communities* ....................................62 New Beef Products Add Value* ................................................. 63 Panhandle Chicory Production* ....................................65 Sandhills Leadership Program* ................................................ 66 Technologies Across Nebraska* ....................................67 Society-Ready Graduates Animal Welfare Class ..................................................................... 68 Employment Seminar ............................................................. 69 Entomology Distance Education Master\u27s Degree ........................................... 70 Feedlot Management Specialization Internship ............................ 71 Food Product Development Class ................................................ 72 Innovative Uses for Soybeans ........................................................ 73 Pollution Prevention Internship .................................................................. 74 Student Development Initiative ..................................................... 76 Agricultural Science Magnet Schools*............................................... 77 America\u27s Farm* ...................................................................... 78 Bug Bash* .................................................................................. 79 Nebraska Beef Team* ........................................................ 8

Improving surgical quality in low-income and middle-income countries: why do some health facilities perform better than others?

BACKGROUND: Evidence on heterogeneity in outcomes of surgical quality interventions in low-income and middle-income countries is limited. We explored factors driving performance in the Safe Surgery 2020 intervention in Tanzania's Lake Zone to distil implementation lessons for low-resource settings. METHODS: We identified higher (n=3) and lower (n=3) performers from quantitative data on improvement from 14 safety and teamwork and communication indicators at 0 and 12 months from 10 intervention facilities, using a positive deviance framework. From 72 key informant interviews with surgical providers across facilities at 1, 6 and 12 months, we used a grounded theory approach to identify practices of higher and lower performers. RESULTS: Performance experiences of higher and lower performers differed on the following themes: (1) preintervention context, (2) engagement with Safe Surgery 2020 interventions, (3) teamwork and communication orientation, (4) collective learning orientation, (5) role of leadership, and (6) perceived impact of Safe Surgery 2020 and beyond. Higher performers had a culture of teamwork which helped them capitalise on Safe Surgery 2020 to improve surgical ecosystems holistically on safety practices, teamwork and communication. Lower performers prioritised overhauling safety practices and began considering organisational cultural changes much later. Thus, while also improving, lower performers prioritised different goals and trailed higher performers on the change continuum. CONCLUSION: Future interventions should be tailored to facility context and invest in strengthening teamwork, communication and collective learning and facilitate leadership engagement to build a receptive climate for successful implementation of safe surgery interventions