wow-inequalities/02-data/intermediate/wos_sample/14927bc1592c606c7e48f290416656b8-hanna-joseph-s.-and/info.yaml

abstract: 'Background Surgical, anaesthetic, and obstetric (SAO) health-care system

  strengthening is needed to address the emergency and essential surgical

  care that approximately 5 billion individuals lack globally. To our

  knowledge, a complete, non-modelled national situational analysis based

  on the Lancet Commission on Global Surgery surgical indicators has not

  been done. We aimed to undertake a complete situation analysis of SAO

  system preparedness, service delivery, and financial risk protection

  using the core surgical indicators proposed by the Commission in

  Colombia, an upper-middle-income country.

  Methods Data to inform the six core surgical system indicators were

  abstracted from the Colombian national health information system and the

  most recent national health survey done in 2007. Geographical access to

  a Bell wether hospital (defined as a hospital capable of providing

  essential and emergency surgery) within 2 h was assessed by determining

  2 h drive time boundaries around Bellwether facilities and the

  population within and outside these boundaries. Physical 2 h access to a

  Bellwether was determined by the presence of a motor vehicle suitable

  for individual transportation. The Department Administrativo Nacional de

  Estadistica population projection for 2016 and 2018 was used to

  calculate the SAO provider density. Total operative volume was

  calculated for 2016 and expressed nationally per 100 000 population. The

  total number of postoperative deaths that occurred within 30 days of a

  procedure was divided by the total operative volume to calculate the

  all-cause, non-risk-adjusted postoperative mortality. The proportion of

  the population subject to impoverishing costs was calculated by

  subtracting the baseline number of impoverished individuals from those

  who fell below the poverty line once out-of-pocket payments were

  accounted for. Individuals who incurred out-of-pocket payments that were

  more than 10\% of their annual household income were considered to have

  experienced catastrophic expenditure. Using GIS mapping, SAO system

  preparedness, service delivery, and cost protection were also

  contextualised by socioeconomic status.

  Findings In 2016, at least 7.1 million people (15.1\% of the population)

  in Colombia did not have geographical access to SAO services within a 2

  h driving distance. SAO provider density falls short of the Commission''s

  minimum target of 20 providers per 100 000 population, at an estimated

  density of 13.7 essential SAO health-care providers per 100 000

  population in 2018. Lower socioeconomic status of a municipality, as

  indicated by proportion of people enrolled in the subsidised insurance

  regime, was associated with a smaller proportion of the population in

  the municipality being within 2 h of a Bellwether facility, and the most

  socioeconomically disadvantaged municipalities often had no SAO

  providers. Furthermore, Colombian providers appear to be working at or

  beyond capacity, doing 2690-3090 procedures per 100 000 population

  annually, but they have maintained a relatively low median postoperative

  mortality of 0.74\% (IQR 0.48-0.84). Finally, out-of-pocket expenses for

  indirect health-care costs were a key barrier to accessing surgical

  care, prompting 3.1 million (6.4\% of the population) individuals to

  become impoverished and 9.5 million (19.4\% of the population)

  individuals to incur catastrophic expenditures in 2007.

  Interpretation We did a non-modelled, indicator-based situation analysis

  of the Colombian SAO system, finding that it has not yet met, but is

  working towards achieving, the targets set by the Lancet Commission on

  Global Surgery. The observed interdependence of these indicators and

  correlation with socioeconomic status are consistent with well

  recognised factors and outcomes of social, health, and health-care

  inequity. The internal consistency observed in Colombia''s situation

  analysis validates the use of the indicators and has now informed

  development of an early national SAO plan in Colombia, to set a

  data-informed stage for implementation and evaluation of timely, safe,

  and affordable SAO health care, within the National Public Health

  Decennial Plan, which is due in 2022. Copyright (C) 2020 The Author(s).

  Published by Elsevier Ltd.'
affiliation: 'Hanna, JS (Corresponding Author), Rutgers State Univ, Rutgers Robert
  Wood Johnson Med Sch, New Brunswick, NJ 08903 USA.

  Hanna, Joseph S.; Sabatino, Marlena E.; Hamilton, Charles; Rehman, Shahyan U.; Mendoza,
  Ardi Knobel; Nemoyer, Rachel; Scott, Michael; Gracias, Vicente; Peck, Gregory L.,
  Rutgers State Univ, Rutgers Robert Wood Johnson Med Sch, New Brunswick, NJ 08903
  USA.

  Herrera-Almario, Gabriel E.; Valencia, Sergio A.; Londono, Dario, Fdn Santa Fe Bogota,
  Bogota, Colombia.

  Herrera-Almario, Gabriel E.; Pinilla-Roncancio, Monica; Bernal, Liliana Carolina
  Gomez; Salas, Maria Fernanda Moreno; Navarro, Maria Alejandra Pena, Univ los Andes,
  Sch Med, Bogota, Colombia.

  Tulloch, David, State Univ New Jersey, Rutgers Sch Environm \& Biol Sci, Ctr Remote
  Sensing \& Spatial Anal, New Brunswick, NJ USA.

  Pardo-Bayona, Mariana; Dario-Gonzalez, Ivan, Colombian Minist Hlth \& Social Protect,
  Bogota, Colombia.

  Rubiano, Andres M., Univ Bosque, Sch Med, Bogota, Colombia.

  Rubiano, Andres M., Univ Bosque, Neurosci Inst, Bogota, Colombia.

  Ramirez, Mauricio Vasco, Univ CES, Medellin, Colombia.

  Gracias, Vicente, Rutgers State Univ, Rutgers New Jersey Med Sch, Newark, NJ USA.

  Peck, Gregory L., Rutgers Biomed \& Hlth Sci, Rutgers Sch Publ Hlth, Piscataway,
  NJ USA.'
author: Hanna, Joseph S. and Herrera-Almario, Gabriel E. and Pinilla-Roncancio, Monica
  and Tulloch, David and Valencia, Sergio A. and Sabatino, Marlena E. and Hamilton,
  Charles and Rehman, Shahyan U. and Mendoza, Ardi Knobel and Bernal, Liliana Carolina
  Gomez and Salas, Maria Fernanda Moreno and Navarro, Maria Alejandra Pena and Nemoyer,
  Rachel and Scott, Michael and Pardo-Bayona, Mariana and Rubiano, Andres M. and Ramirez,
  Mauricio Vasco and Londono, Dario and Dario-Gonzalez, Ivan and Gracias, Vicente
  and Peck, Gregory L.
author-email: joseph.hanna@rutgers.edu
author_list:
- family: Hanna
  given: Joseph S.
- family: Herrera-Almario
  given: Gabriel E.
- family: Pinilla-Roncancio
  given: Monica
- family: Tulloch
  given: David
- family: Valencia
  given: Sergio A.
- family: Sabatino
  given: Marlena E.
- family: Hamilton
  given: Charles
- family: Rehman
  given: Shahyan U.
- family: Mendoza
  given: Ardi Knobel
- family: Bernal
  given: Liliana Carolina Gomez
- family: Salas
  given: Maria Fernanda Moreno
- family: Navarro
  given: Maria Alejandra Pena
- family: Nemoyer
  given: Rachel
- family: Scott
  given: Michael
- family: Pardo-Bayona
  given: Mariana
- family: Rubiano
  given: Andres M.
- family: Ramirez
  given: Mauricio Vasco
- family: Londono
  given: Dario
- family: Dario-Gonzalez
  given: Ivan
- family: Gracias
  given: Vicente
- family: Peck
  given: Gregory L.
da: '2023-09-28'
files: []
issn: 2214-109X
journal: LANCET GLOBAL HEALTH
keywords-plus: 'INFORMING NATIONAL STRATEGIES; SCALING-UP SURGERY; HEALTH; CARE;

  COUNTRIES; MORTALITY; ACCESS; SYSTEM; PLAN'
language: English
month: MAY
number: '5'
number-of-cited-references: '43'
orcid-numbers: 'Sabatino, Marlena/0000-0003-3029-3468

  Moreno Salas, Maria Fernanda/0000-0001-8046-8479

  Hamilton, Charles/0000-0003-1042-9575

  Tulloch, David/0000-0002-0692-9190

  Valencia, Sergio Alfonso/0000-0002-0605-411X

  Pinilla-Roncancio, Monica/0000-0002-1443-4649

  Rehman, Shahyan/0000-0002-9667-3255'
pages: E699-E710
papis_id: a968200b434ccfe36a7d26cb6870bdf0
ref: Hanna2020usesix
researcherid-numbers: 'Scott, Michael/AAY-3110-2021

  '
times-cited: '36'
title: 'Use of the six core surgical indicators from the Lancet Commission on Global
  Surgery in Colombia: a situational analysis'
type: article
unique-id: WOS:000529064000028
usage-count-last-180-days: '0'
usage-count-since-2013: '5'
volume: '8'
web-of-science-categories: Public, Environmental \& Occupational Health
year: '2020'