Sameen Siddiqi1, Muhammad Sohaib Khan2, Narjis Rizvi1, Imran Naeem1, Shafquat Rozi1, Ather Enam2, Sadaf Khan3. 1. Department of Community Health Sciences, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan. 2. Department of Surgery, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan. 3. Department of Surgery, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan. sadaf.khan@aku.edu.
Abstract
BACKGROUND: Access to essential surgical care is vital for reduction in mortality and morbidity as a result of surgical conditions. These account for 28-32% of the overall global burden of disease, yet billions of people lack access to safe, affordable surgical and anesthesia care when needed. The purpose of this study was to assess the capacity for surgical care in rural hospitals across four provinces of Pakistan. METHODS: This was a cross-sectional study undertaken in 10 rural hospitals across four provinces of the country. Of these, six were district and four sub-district hospitals that were purposively selected in consultation with the government. Data were gathered using the WHO-PGSSC Surgical Assessment Tool. RESULTS: This study estimated 3 of the 6 indicators proposed by the Lancet Commission on Global Surgery. While most hospitals had basic provisions of infrastructure and equipment, severe shortage of specialists was observed with 0.56 specialists (surgeons, gynecologists and anesthetists) present per 100,000 population. Two-hour access was possible for the catchment population of 7 out of the 10 hospitals. Of the 43 essential surgical procedures assessed, 13 or 30% procedures were available per hospital. The three Bellwether procedures were provided by only 1 hospital. Mean number of surgeries performed was 753 ± 979 per 100,000 population. CONCLUSIONS: Our study has demonstrated major gaps in the provision of surgical care in rural hospitals in Pakistan. While developing a strategy and national action plan is necessary, implementation can immediately begin at the local level to address the gaps that need urgent attention.
BACKGROUND: Access to essential surgical care is vital for reduction in mortality and morbidity as a result of surgical conditions. These account for 28-32% of the overall global burden of disease, yet billions of people lack access to safe, affordable surgical and anesthesia care when needed. The purpose of this study was to assess the capacity for surgical care in rural hospitals across four provinces of Pakistan. METHODS: This was a cross-sectional study undertaken in 10 rural hospitals across four provinces of the country. Of these, six were district and four sub-district hospitals that were purposively selected in consultation with the government. Data were gathered using the WHO-PGSSC Surgical Assessment Tool. RESULTS: This study estimated 3 of the 6 indicators proposed by the Lancet Commission on Global Surgery. While most hospitals had basic provisions of infrastructure and equipment, severe shortage of specialists was observed with 0.56 specialists (surgeons, gynecologists and anesthetists) present per 100,000 population. Two-hour access was possible for the catchment population of 7 out of the 10 hospitals. Of the 43 essential surgical procedures assessed, 13 or 30% procedures were available per hospital. The three Bellwether procedures were provided by only 1 hospital. Mean number of surgeries performed was 753 ± 979 per 100,000 population. CONCLUSIONS: Our study has demonstrated major gaps in the provision of surgical care in rural hospitals in Pakistan. While developing a strategy and national action plan is necessary, implementation can immediately begin at the local level to address the gaps that need urgent attention.
Authors: Sandro Contini; Asadullah Taqdeer; Meena Cherian; Ahmad Shah Shokohmand; Richard Gosselin; Peter Graaff; Luc Noel Journal: World J Surg Date: 2010-03 Impact factor: 3.352
Authors: Anna J Dare; Caris E Grimes; Rowan Gillies; Sarah L M Greenberg; Lars Hagander; John G Meara; Andrew J M Leather Journal: Lancet Date: 2014-05-19 Impact factor: 79.321
Authors: Blake C Alkire; Mark G Shrime; Anna J Dare; Jeffrey R Vincent; John G Meara Journal: Lancet Glob Health Date: 2015-04-27 Impact factor: 26.763
Authors: John G Meara; Andrew J M Leather; Lars Hagander; Blake C Alkire; Nivaldo Alonso; Emmanuel A Ameh; Stephen W Bickler; Lesong Conteh; Anna J Dare; Justine Davies; Eunice Dérivois Mérisier; Shenaaz El-Halabi; Paul E Farmer; Atul Gawande; Rowan Gillies; Sarah L M Greenberg; Caris E Grimes; Russell L Gruen; Edna Adan Ismail; Thaim Buya Kamara; Chris Lavy; Ganbold Lundeg; Nyengo C Mkandawire; Nakul P Raykar; Johanna N Riesel; Edgar Rodas; John Rose; Nobhojit Roy; Mark G Shrime; Richard Sullivan; Stéphane Verguet; David Watters; Thomas G Weiser; Iain H Wilson; Gavin Yamey; Winnie Yip Journal: Lancet Date: 2015-04-26 Impact factor: 79.321
Authors: Joshua S Ng-Kamstra; Sarah L M Greenberg; Fizan Abdullah; Vanda Amado; Geoffrey A Anderson; Matchecane Cossa; Ainhoa Costas-Chavarri; Justine Davies; Haile T Debas; George S M Dyer; Sarnai Erdene; Paul E Farmer; Amber Gaumnitz; Lars Hagander; Adil Haider; Andrew J M Leather; Yihan Lin; Robert Marten; Jeffrey T Marvin; Craig D McClain; John G Meara; Mira Meheš; Charles Mock; Swagoto Mukhopadhyay; Sergelen Orgoi; Timothy Prestero; Raymond R Price; Nakul P Raykar; Johanna N Riesel; Robert Riviello; Stephen M Rudy; Saurabh Saluja; Richard Sullivan; John L Tarpley; Robert H Taylor; Louis-Franck Telemaque; Gabriel Toma; Asha Varghese; Melanie Walker; Gavin Yamey; Mark G Shrime Journal: BMJ Glob Health Date: 2016-04-06