Original CommunicationPrioritizing essential surgery and safe anesthesia for the Post-2015 Development Agenda: Operative capacities of 78 district hospitals in 7 low- and middle-income countries
Section snippets
Survey design
Surveys were conducted using a comprehensive survey tool adapted by the HHI from the WHO Tool for Situational Analysis to Assess Emergency and Essential Surgical Care.40 Both survey tools assessed operative capacity on the basis of the following eight areas of surgical provision: access and availability, human resources, infrastructure, outcomes recording, types of operations performed, equipment availability, blood products, and pharmaceutical capacity.
Data collection
Surveys were conducted from 2011 to 2012.
Surveyed hospitals
Seventy-eight government district hospitals were surveyed in seven LMICs: Bangladesh (n = 7),34 Bolivia (n = 11),35 Ethiopia (n = 6),32 Liberia (n = 11),33 Nicaragua (n = 10),38 Rwanda (n = 21),37 and Uganda (n = 12)36 (Table I).32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43 On the basis of gross national income per capita, the World Bank classifies five of these as low-income countries (Bangladesh, Ethiopia, Liberia, Rwanda, and Uganda) and two as lower-middle-income countries (Bolivia and
Discussion
The prevalence of surgical disease is on the rise.45 This is the result of an increase in noncommunicable diseases such as cancer and trauma as well as the fact that surgical services have been neglected in LMICs for decades.46 It is therefore important to understand the capacity of district hospitals to provide essential surgery and safe anesthesia. The objective of this study was to survey the operative capacities of district hospitals in multiple LMICs. We assessed a total of 78 government
Conclusion
The comparative data presented here represent a comprehensive summary of extensive data on surgical and anesthesia infrastructure in several LMICs. These data should inform the global public health community as the Post-2015 Development Agenda is being defined. No longer can the burden of surgical disease be denied as an important contributor to premature disability and death due to an absence of data. Essential surgery and safe anesthesia must be part of a comprehensive health strategy in
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Funded by the Harvard Humanitarian Initiative, Harvard Program in Global Surgery and Social Change, Massachusetts General Hospital (MGH) Global Health Center of Expertise, MGH International Trauma and Disaster Institute, Brigham and Women's Hospital Department of Emergency Medicine, Thomas J. Watson Foundation, Global Surgical Consortium, Duke Global Health Residency/Fellowship Pathway, US Fulbright Program, and the Harvard School of Public Health.