Introduction
Five billion of the world’s seven billion population lack access to safe, affordable and timely surgical and anaesthesia care.1 This leads to preventable mortality, unnecessary disability and uncorrected deformity that negatively impact health and economic activity.2–5
The World Health Assembly (WHA) resolution A 68/15 passed in May 2015 addressed the need to ‘Strengthen Emergency and Essential Surgical Care and Anaesthesia as a part of Universal Health Coverage’.6 In order to achieve this in low-income and middle-income countries (LMICs) and improve their ability to deliver emergency and essential surgical care, it is necessary to measure access in terms of capability, capacity, timeliness, safety and affordability.7 8
The Lancet Commission on Global Surgery (LCoGS) recommended six surgical metrics that would enable countries and their ministries of health to measure surgical care delivery and monitor progress.1 These metrics have been included in WHO’s 100 Health Indicators,9 and four have already been adopted by the World Bank.10
In 2015, the Bangkok Declaration encouraged signatories to propagate the Commission’s key messages, promote research on access to safe, affordable and timely surgery, and report on the WHO’s and the Commission’s recommended surgical indicators.11 Subsequently, Asia-Pacific representatives at the 4th Royal Australasian College of Surgeons (RACS) Global Health Symposium, held in association with the LCoGS in Melbourne in October 2015, resolved to obtain data on the first four of six global surgery metrics for countries in their region.
This paper reports on LCoGS indicators collected in the Asia-Pacific region. It also presents the practical challenges in obtaining the data in low-income countries with limited health information technology.
English-speaking countries in the South Pacific were invited to collaborate in the collection of the first four of six LCoGS indicators. To do so, the RACS established a working group through its collegial network with a clinical representative from each country. An information document, containing background information and indicator definitions, and a spreadsheet were distributed via email. The working group was supported by a precollection feasibility survey, an online chat group and regular teleconferences over a 6-month period from October 2015 to April 2016. The representative was asked to seek permission with the appropriate authority in their own country and their data were only included once this permission was granted.
The definition for each indicator was taken from the Global Surgery 2030 report and summarised in table 1. The practical methodology of collecting the LCoGS indicators for each country is presented in table 2. The methodology was guided by the working group to determine a consensus view where previously unanticipated questions arose or seeking further clarification and advice from LCoGS Commissioners or authors (JM, DW).1
Fourteen countries provided data in this collaborative process and a summary of the results is presented in table 3.
Financial risk protection indicators were not collected, although there were already modelled estimates for many countries in our region, which are included in table 4. These will likely require adjustment or corroboration by further research.