Facility-level data that look at surgical equipment, workforce and infrastructure are needed

Tools such as the WHO Situation Assessment Tool35 can be useful for determining facility-level capabilities

Look at operating room density/100 000 population as an adjunct indicator when basic parameters of access are met

Address large geographic disparities for SAO

Consider rural residency training in addition to rural medical education

Address the shortage of anaesthesia providers

Disaggregate the surgical workforce density by specialty to find nuances

Assess internal distribution to look for regional deficiencies

Use full-time equivalent of SAO in the public sector as an adjunct indicator

Measure and report private surgical volume

Address geographic disparities in public sector volume

Monitor overuse as access continues to improve

Assess internal distribution to look for regional deficiencies

Monitor overuse by evaluating case-mix

Ensure accurate reporting

Develop a national strategy for assessing and improving postoperative outcomes

Consider procedure-specific perioperative mortality rates to minimise variation in patient risk

Investigate what expenditures are being passed on to the patient

Expand financial risk protection beyond the cost of procedures

As an adjunct, consider patient-level analyses to disaggregate what contributes to out-of-pocket expenditure

Consider the effect of out-of-pocket expenditure on different income strata