A geospatial evaluation of timely access to surgical care in seven countries.

OBJECTIVE: To assess the consistent availability of basic surgical resources at selected facilities in seven countries. METHODS: In 2010-2014, we used a situational analysis tool to collect data at district and regional hospitals in Bangladesh (n = 14), the Plurinational State of Bolivia (n = 18), Ethiopia (n = 19), Guatemala (n = 20), the Lao People's Democratic Republic (n = 12), Liberia (n = 12) and Rwanda (n = 25). Hospital sites were selected by pragmatic sampling. Data were geocoded and then analysed using an online data visualization platform. Each hospital's catchment population was defined as the people who could reach the hospital via a vehicle trip of no more than two hours. A hospital was only considered to show consistent availability of basic surgical resources if clean water, electricity, essential medications including intravenous fluids and at least one anaesthetic, analgesic and antibiotic, a functional pulse oximeter, a functional sterilizer, oxygen and providers accredited to perform surgery and anaesthesia were always available. FINDINGS: Only 41 (34.2%) of the 120 study hospitals met the criteria for the provision of consistent basic surgical services. The combined catchments of the study hospitals in each study country varied between 3.3 million people in Liberia and 151.3 million people in Bangladesh. However, the combined catchments of the study hospitals in each study country that met the criteria for the provision of consistent basic surgical services were substantially smaller and varied between 1.3 million in Liberia and 79.2 million in Bangladesh. CONCLUSION: Many study facilities were deficient in the basic infrastructure necessary for providing basic surgical care on a consistent basis.

Surgical and anesthesia capacity in Bolivian public hospitals: results from a national hospital survey.

BACKGROUND: Underdeveloped nations suffer from significant deficiencies in surgical and anesthesia care. Although surgical inequities are a pressing issue internationally, the extent of these inequities is unknown due to a lack of data. The aim of this study was to assess surgical and anesthesia capacity in Bolivia as part of a multinational study assessing surgical and anesthesia infrastructure in Africa, Latin America, and South Asia. METHODS: A standardized survey tool was used to obtain national-level health-care data at the Bolivian Ministry of Health. Hospital-specific data were obtained through interviews with key administrators and providers at 18 public basic and general hospitals in Bolivia. RESULTS: There are 1,270 obstetrician/gynecologists and 1,807 surgeons in Bolivia. In contrast, there are 500 anesthesiologists, placing a large anesthesia burden on the country. Basic hospitals and general hospitals performed an average of 730 and 2,858 operations per year, respectively. One basic hospital was unable to perform any surgeries due to a lack of surgical manpower. All but two hospitals reported some lack of infrastructure, equipment, or pharmaceutical capacity. The ability to collect health outcomes was inconsistent in most hospitals. CONCLUSIONS: Surgical capacity varies throughout Bolivia. There are relatively large numbers of surgery providers but an insufficient number of anesthesiologists, suggesting a specific need for further development in anesthesia. Though there are many areas of strength within the Bolivian public health-care system, this survey identified several areas to which national policy and international collaboration can contribute in order to more adequately address major causes of surgical morbidity and mortality.