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Thesis Format

Integrated Article

Degree

Master of Science

Program

Epidemiology and Biostatistics

Supervisor

Martin, Janet

Abstract

The Lancet Commission on Global Surgery proposed six core indicators to track access to safe, timely, and affordable surgery. We identified published data for countries reporting Indicator 1 (Access to timely essential surgery), defined as a country’s proportion of population living within two hours from the nearest surgery-capable facility, and conducted geospatial analyses to estimate this metric in other countries. In the primary analysis using this data, linear regression models were run to project this indicator for all countries globally according to their Human Development Index; followed by secondary analyses using broader definitions for surgical access, then by sensitivity analyses restricting these definitions. Our primary analysis showed that only a quarter of countries around the world have at least 80% of population with timely access to surgery in 2021. Continued efforts in reporting Indicator 1 and standardizing the definition and methods used to quantify it will be essential in ensuring the comparability and utility of the data across all countries.

Summary for Lay Audience

Surgery has been called the ‘neglected stepchild of global health,’ and anaesthesia the ‘invisible friend’ of the neglected stepchild. While provision of basic surgical and anaesthesia care could avert about 1.5 million deaths per year, it is often misconstrued as ‘too costly’ and ‘too complex’ to prioritize in the planning of international health systems. The Lancet Commission on Global Surgery proposed six core indicators to quantify the level of access to safe, timely, and affordable surgery, and encouraged routine country-level reporting. We found that Indicator 1 (Access to timely essential surgery), is one of the most reported of the six proposed indicators, but comprehensive reviews of this metric are few, and global projections have not been performed recently. Geographic proximity is one of the main barriers to accessing surgical services and the associated travel time is consistently found to significantly impact health outcomes before and after surgery. Indicator 1 aims to target these challenges and effectively inform the level of preparedness of a national health system.

We identified publications reporting Indicator 1, as defined by a country’s proportion of population living within two hours from the nearest facility capable of providing essential surgery, and directly estimated this indicator in other countries using geospatial analysis. The collected data was then used to project Indicator 1 for all countries around the world based on their level of development, measured by the Human Development Index. We found that in 2021, only a quarter of countries around the world have at least 80% of population that can reach a surgical facility when needed. Importantly, our analysis revealed that these estimates varied depending on the methods used to define and collect the data elements. Standardizing the methods used to define and quantify the indicators is required to accurately capture the state of surgical access in all countries. Equitable access to surgery is only achieved through standardized, transparent reporting of openly available, comparable, and utilizable data on the core indicators.

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