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Lim X, Ayyappan M, Zaw MWW, Mandyam NK, Chia HX, Lucero-Prisno DE. Geospatial mapping of 2-hour access to timely essential surgery in the Philippines. BMJ Open 2023; 13:e074521. [PMID: 38101847 PMCID: PMC10728984 DOI: 10.1136/bmjopen-2023-074521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 11/29/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVES Timely access to safe and affordable surgery is essential for universal health coverage. To date, there are no studies evaluating 2-hour access to Bellwether procedures (caesarean section, laparotomy, open fracture management) in the Philippines. The objectives of this study were to measure the proportion of the population able to reach a Bellwether hospital within 2 hours in the Philippines and to identify areas in the country with the most surgically underserved populations. METHODS All public hospitals with Bellwether capacities were identified from the Philippines Ministry of Health website. The service area tool in ArcGIS Pro was used to determine the population within a 2-hour drive time of a Bellwether facility. Finally, suitability modelling was conducted to identify potential future sites for a surgical facility that targets the most underserved regions in the Philippines. RESULTS 428 Bellwether capable hospitals were identified. 85.1% of the population lived within 2 hours of one of these facilities. However, 6 regions had less than 80% of its population living within 2 hours of a Bellwether capable facility: Bicol, Eastern Visayas, Zamboanga, Autonomous region of Muslim Mindanao, Caraga and Mimaropa. Suitability analysis identified four regions-Caraga, Mimaropa, Calabarzon and Zamboanga-as ideal locations to build a new hospital with surgical capacity to improve access rates. CONCLUSION 85.1% of the population of the Philippines are able to reach Bellwether capable hospitals within 2 hours, with regional disparities in terms of access rates. However, other factors such as weather, traffic conditions, financial access, availability of 24-hour surgical services and access to motorised vehicles should also be taken into consideration, as they also affect actual access rates.
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Affiliation(s)
- Xuxin Lim
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
- Harvard Program in Global Surgery and Social Change, Boston, Massachusetts, USA
| | | | - Ma Wai Wai Zaw
- Division of Anesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore
| | | | - Hui Xiang Chia
- National University Singapore Saw Swee Hock School of Public Health, Singapore
| | - Don Eliseo Lucero-Prisno
- Faculty of Management and Development Studies, University of the Philippines Open University, Laguna, Calabarzon, Philippines
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, London, UK
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Qin RX, Fowler ZG, Jayaram A, Stankey M, Yoon S, McLeod E, Park KB. The current status of surgical care in the Asia-Pacific region and opportunities for improvement: proceedings. BMC Proc 2023; 17:12. [PMID: 37488551 PMCID: PMC10367230 DOI: 10.1186/s12919-023-00255-0] [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
The World Health Assembly resolution 68.15 recognised emergency and essential surgery as a critical component of universal health coverage. The first session of the three-part virtual meeting series on Strategic Planning to Improve Surgical, Obstetric, Anaesthesia, and Trauma Care in the Asia-Pacific Region focused on the current status of surgical care and opportunities for improvement. During this session, Ministries of Health and World Health Organization (WHO) Regional Directors shared country- and regional-level progress in surgical system strengthening. The WHO Western Pacific Regional Office (WPRO) has developed an Action Framework for Safe and Affordable Surgery, whilst the WHO South-East Asia Regional Office (SEARO) highlighted their efforts in emergency obstetric care, workforce strengthening, and blood safety. Numerous countries have begun developing and implementing National Surgical, Obstetric, and Anaesthesia Plans (NSOAPs). Participants agreed surgical system strengthening is an integral component of universal health coverage, pandemic preparedness, and overall health system resilience. Participants discussed common challenges, such as the COVID-19 pandemic, climate change, workforce capacity building, and improving access for hard-to-reach populations. They generated and shared common solutions, including strengthening surgical care capacity in first-level hospitals, anaesthesia task-shifting, remote training, and integrating surgical care with public health, preventive care, and emergency preparedness. Moving forward, participants committed to developing and implementing NSOAPs and agreed on the need to raise political awareness, build a broad-based movement, and form intersectoral collaborations.
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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.
| | - 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
| | - 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
| | - Elizabeth McLeod
- Department of Neonatal and Paediatric Surgery, Royal Children's Hospital, 50 Flemington Rd, Melbourne, VIC, 3052, Australia
| | - 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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Monitoring Indicators of Universal Access to Accessible and Safe Anesthetic and Surgical Care in a Peruvian Region: An Ambispective Study. J Surg Res 2023; 283:127-136. [PMID: 36403406 PMCID: PMC10118244 DOI: 10.1016/j.jss.2022.10.024] [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: 02/04/2022] [Revised: 08/23/2022] [Accepted: 10/15/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The Lancet Commission on Global Surgery indicators for monitoring anesthetic and surgical care allow the identification of access barriers, evaluate the safety of surgeries, facilitate planning, and assess changes over time. The primary objective was to measure these indicators in all health facilities of a Peruvian region in 2020. METHODS This was an ambispective observational study to measure the anesthetic and surgical care indicators in Piura, a region in Peru, between January 2020 and June 2021. Public and private health facilities in the Piura region that performed surgical care or had specialists from any surgical specialty participated in the study. Data were collected from all regional health facilities that provided surgical care to estimate the density of surgical workforce. Likewise, the percentage of the population with access to an operating room within 2 h was estimated using georeferenced tools. Finally, a public database was accessed to determine the surgical volume, the percentage of the regional population protected with health insurance. RESULTS In 2020, 88.4% of the inhabitants of this Peruvian region had access to timely essential surgery. There were 18.4 surgical specialists and 1174 surgeries per 100,000 populations, and 91% of the population had health insurance. In addition, there was a rate of 2.1 working operating rooms per 100,000 inhabitants in 2021. CONCLUSIONS This Peruvian region presented an increasing trend with respect to the population's access to essential and timely surgical care, and health insurance coverage. However, the workforce distribution was inequitable among the provinces of the region, the surgical volume was reduced, and timely access was hindered because of the SARS-CoV-2 pandemic.
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Siow SL, Wahab MYA, Chuah JS, Mahendran HA. Access to essential surgical care in district hospitals of Sarawak Malaysia: outcomes of an audit and the need for urgent attention. ANZ J Surg 2022; 92:1692-1699. [DOI: 10.1111/ans.17705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 02/02/2022] [Accepted: 03/27/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Sze Li Siow
- Department of General Surgery Sarawak General Hospital Kuching Sarawak Malaysia
| | | | - Jun Sen Chuah
- Department of General Surgery Sarawak General Hospital Kuching Sarawak Malaysia
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Yap JF, Ng QX, Wai YZ, Isahak M, Salowi MA, Moy FM. Prevalence of cataract and factors associated with cataract surgery uptake among older persons in Malaysia: A cross-sectional study from the National Eye Survey II. Trop Doct 2022; 52:325-330. [DOI: 10.1177/00494755221076649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Nationally-representative evidence is limited on factors affecting uptake of cataract surgery in Malaysia. We found the prevalence of cataract among older persons to be 26.8%. The two most common barriers were ‘need not felt’ (43.5%) and ‘fear of surgery or poor result’ (16.2%). Reluctance for surgical intervention was greater outside the Central zone.
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Affiliation(s)
- Jun Fai Yap
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Qi Xiong Ng
- Department of Ophthalmology, Hospital Queen Elizabeth, Sabah, Malaysia
| | - Yong Zheng Wai
- Department of Ophthalmology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Marzuki Isahak
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohamad Aziz Salowi
- Department of Ophthalmology, Hospital Serdang, Selangor, Malaysia
- Department of Ophthalmology, Faculty of Medicine, Universiti Sultan Zainal Abidin, Terengganu, Malaysia
| | - Foong Ming Moy
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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