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'