Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development

Meara, John G.; Leather, Andrew J M; Hagander, Lars; Alkire, Blake C; Alonso, Nivaldo; Ameh, Emmanuel A.; Bickler, Stephen W.; Conteh, Lesong; Dare, Anna J; Davies, Justine; Mérisier, Eunice D érivois; El-Halabi, Shenaaz; Farmer, Paul; Gawande, Atul A.; Gillies, Robyn M.; Greenberg, Sarah L M; Grimes, Caris; Gruen, Russell L.; Ismail, Edna Adan; Kamara, Thaim B.; Lavy, Chris; Lundeg, Ganbold; Mkandawire, Nyengo; Raykar, Nakul; Riesel, Johanna N; Rodas, Edgar B.; Rose, John; Roy, Nobhojit; Shrime, Mark G.; Sullivan, Richard; Verguet, Stéphane; Watters, David; Weiser, Thomas; Wilson, Iain; Yamey, Gavin; Yip, Winnie

doi:10.1016/s0140-6736(15)60160-x

Cited by 2,562 publications

(2,304 citation statements)

References 209 publications

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“…Low‐income countries struggle with an insufficient surgical workforce; the surgical specialist workforce density is 0·7 per 100 000 population5, far below the recommendation1 of 20 per 100 000 population. In addition, surgical facilities and equipment are often inadequate6.…”

Section: Introductionmentioning

confidence: 97%

“…Surgical care in low‐ and middle‐income countries (LMICs) has suffered from insufficient prioritization, especially in rural settings1, 2, 3, 4. Low‐income countries struggle with an insufficient surgical workforce; the surgical specialist workforce density is 0·7 per 100 000 population5, far below the recommendation1 of 20 per 100 000 population.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, surgical facilities and equipment are often inadequate6. The combination of lack of trained personnel and equipment has resulted in a lack of safe and affordable access to surgical care for 90 per cent of patients who need it, contributing to high rates of surgical morbidity and mortality in LMICs1.…”

Section: Introductionmentioning

confidence: 99%

“…It is now recognized that surgical care has a central role in the management of many medical conditions1, but little is known about the cost of providing surgical care in LMICs. Because of a history of patients with conditions that need surgical intervention being referred to higher‐level hospitals and the perception that higher‐level hospitals should provide surgery, surgical care is often viewed as expensive compared with the medical management of other diseases2 3, 7.…”

Section: Introductionmentioning

confidence: 99%

“…The Lancet Commission on Global Surgery recommended that caesarean section, laparotomy and open fracture treatment, collectively referred to as the ‘bellwether procedures’, be available to patients at district hospitals1. The bellwether procedures are important to provide timely access to these procedures at district hospitals, but their availability also correlates with a facility's ability to perform a broad array of other essential surgical services1.…”

Section: Introductionmentioning

confidence: 99%

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Assessing the cost of laparotomy at a rural district hospital in Rwanda using time-driven activity-based costing

et al. 2018

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BackgroundIn low‐ and middle‐income countries, the majority of patients lack access to surgical care due to limited personnel and infrastructure. The Lancet Commission on Global Surgery recommended laparotomy for district hospitals. However, little is known about the cost of laparotomy and associated clinical care in these settings.MethodsThis costing study included patients with acute abdominal conditions at three rural district hospitals in 2015 in Rwanda, and used a time‐driven activity‐based costing methodology. Capacity cost rates were calculated for personnel, location and hospital indirect costs, and multiplied by time estimates to obtain allocated costs. Costs of medications and supplies were based on purchase prices.ResultsOf 51 patients with an acute abdominal condition, 19 (37 per cent) had a laparotomy; full costing data were available for 17 of these patients, who were included in the costing analysis. The total cost of an entire care cycle for laparotomy was US$1023·40, which included intraoperative costs of US$427·15 (41·7 per cent) and preoperative and postoperative costs of US$596·25 (58·3 per cent). The cost of medicines was US$358·78 (35·1 per cent), supplies US$342·15 (33·4 per cent), personnel US$150·39 (14·7 per cent), location US$89·20 (8·7 per cent) and hospital indirect cost US$82·88 (8·1 per cent).ConclusionThe intraoperative cost of laparotomy was similar to previous estimates, but any plan to scale‐up laparotomy capacity at district hospitals should consider the sizeable preoperative and postoperative costs. Although lack of personnel and limited infrastructure are commonly cited surgical barriers at district hospitals, personnel and location costs were among the lowest cost contributors; similar location‐related expenses at tertiary hospitals might be higher than at district hospitals, providing further support for decentralization of these services.

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Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Assessing the cost of laparotomy at a rural district hospital in Rwanda using time-driven activity-based costing

et al. 2018

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What Are Criteria for Considering Technologies' Uses and Influences in LMICs' Health Care Infrastructures?

Patterson

Rohrer

2019

AMA Journal of Ethics

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A lack of health technology is an obstacle to health system growth in low-and middle-income countries (LMICs). US-based clinicians participating in global health efforts might sometimes wonder about clinical and ethical standards by which they should judge short-and long-term risks and benefits of bringing technological assistance with them to care for patients in LMICs. These countries are heterogeneous and changing, so establishing an evidence base for clinical and ethical decision making about technology use could be an important priority. This article suggests clinically and ethically relevant criteria according to which health technologies' use and influence can be evaluated. Case A United States school has a relationship with a nongovernmental organization (NGO) in a Latin American country to which faculty and fourth-year students travel for a monthlong elective in global health.

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Maternal and Neonatal Mortality After Cesarean Delivery—Reply

Molina

Weiser

Haynes

2016

JAMA

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Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development

Cited by 2,562 publications

References 209 publications

Assessing the cost of laparotomy at a rural district hospital in Rwanda using time-driven activity-based costing

Assessing the cost of laparotomy at a rural district hospital in Rwanda using time-driven activity-based costing

What Are Criteria for Considering Technologies' Uses and Influences in LMICs' Health Care Infrastructures?

Maternal and Neonatal Mortality After Cesarean Delivery—Reply

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