247 lines
8.1 KiB
YAML
247 lines
8.1 KiB
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'
|