Evaluation Only. Created with Aspose.Pdf. Copyright 2002-2013 Aspose Pty Ltd. Determinants of Access to Surgical Care in Developing Countries
necessarily represent the official position of the affiliated institutions. Dr Wren is on the Editorial Board of JAMA Surgery but was not involved in the editorial review or the decision to accept the manuscript for publication. REFERENCES
Original Investigation Research
7. Gupta S, Shrestha S, Ranjit A, et al. Conditions, preventable deaths, procedures and validation of a countrywide survey of surgical care in Nepal. Br J Surg. 2015;102(6):700-707. 8. Grimes CE, Bowman KG, Dodgion CM, Lavy CBD. Systematic review of barriers to surgical care in low-income and middle-income countries. World J Surg. 2011;35(5):941-950.
15. Luboga S, Macfarlane SB, von Schreeb J, et al; Bellagio Essential Surgery Group (BESG). Increasing access to surgical services in sub-Saharan Africa: priorities for national and international agencies recommended by the Bellagio Essential Surgery Group. PLoS Med. 2009;6(12):e1000200.
9. Groen RS, Samai M, Petroze RT, et al. Pilot testing of a population-based surgical survey tool in Sierra Leone. World J Surg. 2012;36(4):771-774.
16. Colvin M, Gumede L, Grimwade K, Maher D, Wilkinson D. Contribution of traditional healers to a rural tuberculosis control programme in Hlabisa, South Africa. Int J Tuberc Lung Dis. 2003;7(9)(suppl 1):S86-S91.
10. Gupta S, Ranjit A, Shrestha R, et al. Surgical needs of Nepal: pilot study of population based survey in Pokhara, Nepal. World J Surg. 2014;38(12): 3041-3046.
17. Homsy J, King R, Balaba D, Kabatesi D. Traditional health practitioners are key to scaling up comprehensive care for HIV/AIDS in sub-Saharan Africa. AIDS. 2004;18(12):1723-1725.
11. Surgeons OverSeas Assessment of Surgical Need (SOSAS) version 3.0. http://www .adamkushnermd.com/files/SOSAS_survey2.pdf. Accessed October 12, 2015.
18. Dovlo D. Using mid-level cadres as substitutes for internationally mobile health professionals in Africa: a desk review. Hum Resour Health. 2004;2 (1):7.
4. Bickler SW, Weiser TG, Kassebaum N, et al. Global burden of surgical conditions. Disease Control Priorities, Third Edition: Volume 1: Essential Surgery. Washington, DC: World Bank; 2015.
12. Rutherford ME, Mulholland K, Hill PC. How access to health care relates to under-five mortality in sub-Saharan Africa: systematic review. Trop Med Int Health. 2010;15(5):508-519.
19. Mock C, Acheampong F, Adjei S, Koepsell T. The effect of recall on estimation of incidence rates for injury in Ghana. Int J Epidemiol. 1999;28(4):750-755.
5. Petroze RT, Groen RS, Niyonkuru F, et al. Estimating operative disease prevalence in a low-income country: results of a nationwide population survey in Rwanda. Surgery. 2013;153(4): 457-464.
13. Norton I, von Schreeb J, Aitken P, Herard P, Lajolo C. Classification and minimum standards for foreign medical teams in sudden onset disasters. World Health Organization. http://www.who.int/hac /global_health_cluster/fmt_guidelines _september2013.pdf. Published 2013. Accessed October 7, 2015.
1. Farmer PE, Kim JY. Surgery and global health: a view from beyond the OR. World J Surg. 2008;32 (4):533-536. 2. Bae JY, Groen RS, Kushner AL. Surgery as a public health intervention: common misconceptions versus the truth. Bull World Health Organ. 2011;89(6):394. 3. Debas HT, Gosselin R, McCord C, Thind A. Surgery. In: Jamison DT, Breman JG, Measham AR, et al, eds. Disease Control Priorities in Developing Countries. 2nd ed. Washington, DC: World Bank; 2006.
6. Groen RS, Samai M, Stewart KA, et al. Untreated surgical conditions in Sierra Leone: a cluster randomised, cross-sectional, countrywide survey. Lancet. 2012;380(9847):1082-1087.
20. Meara JG, Leather AJM, Hagander L, et al. Global surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386(9993):569-624.
14. Chu K, Rosseel P, Gielis P, Ford N. Surgical task shifting in sub-Saharan Africa. PLoS Med. 2009;6 (5):e1000078.
Invited Commentary
Access to Surgical Care in Developing Countries Tarik Sammour, PhD; Andrew G. Hill, MBChB, MD, EdD(Thesis), FRACS
Universal access to good-quality surgical care is recognized as an essential component of global health.1 In this issue of JAMA Surgery, Forrester et al2 present a comparison of results from 3 separate surveys using the same tool completed by members of the general public in Nepal, Rwanda, and Sierra Leone, with a specific focus on Related article page 257 barriers to access of surgical care in these countries. The authors are to be commended for this work, which yet again demonstrates that, as in many other neighboring countries in the region, there are both unique and common geographical, financial, and societal factors that contribute to inadequate access to surgical care. It remains somewhat unclear why these specific countries were chosen for this study (which also took place during 3 different periods) and what selection bias there may have been in terms of survey responders. Nevertheless, despite any weaknesses that may exist, the study results challenge the reader and the surgical community with a recurring yet daunting question: how can access to surgery be improved in developing jamasurgery.com
countries? And for the well-meaning internationally minded surgeon, how can he or she best help to bridge these huge gaps? As identified in the Global Surgery 2030 report, 1 the basic problem can be broken into 2 major components: accessibility of surgical facilities and the availability of surgical and anesthetic professionals who can deliver that care. Based on the data from the current article, it is clear that access to primary facilities (no operating room) and secondary facilities (operating room but no surgical specialist) was not especially prohibitive in the 3 countries that were assessed. Therefore, it seems the availability of surgical (and probably anesthetic) professionals is the major barrier. One solution to this problem would be to train and educate medical staff at secondary centers in a broad range of basic anesthesia and surgical skills (such as cesarean section, basic fracture management, hernia, and abscess drainage). Programs like this have seen some success in sub-Saharan Africa with a tailor-made university training program for general/ family practitioners trained in these and other important (Reprinted) JAMA Surgery March 2016 Volume 151, Number 3
Copyright 2016 American Medical Association. All rights reserved.
Downloaded From: by a University of Virginia User on 10/06/2017
263
Evaluation Only. Created with Aspose.Pdf. Copyright 2002-2013 Aspose Pty Ltd. Research Original Investigation
Determinants of Access to Surgical Care in Developing Countries
skills.3 Such home-grown efforts are likely to be effective and sustainable, and Western partnerships with such programs are likely to be more effective than the offering of temporary
Conflict of Interest Disclosures: None reported.
ARTICLE INFORMATION Author Affiliations: Royal Adelaide Hospital, Adelaide, South Australia, Australia (Sammour); Middlemore Hospital, University of Auckland, Otahuhu, Auckland, New Zealand (Hill). Corresponding Author: Andrew G. Hill, MBChB, MD, EdD(Thesis), FRACS, University of Auckland, Ko Awatea, Middlemore Hospital, Counties Manukau Health, Private Bag 93311 Otahuhu, Auckland, New Zealand ([email protected]). Published Online: November 4, 2015. doi:10.1001/jamasurg.2015.3434.
264
surgical services led by well-meaning but ad hoc international groups, which all too often plug temporary gaps but offer few, if any, long-term gains.4
REFERENCES 1. Meara JG, Leather AJM, Hagander L, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386(9993):569-624. 2. Forrester JD, Forrester JA, Kamara TB, et al. Self-reported determinants of access to surgical care in 3 developing countries [published online November 4, 2015]. JAMA Surg. doi:10.1001 /jamasurg.2015.3431.
3. van der Voort CTM, van Kasteren G, Chege P, Dinant G-J. What challenges hamper Kenyan family physicians in pursuing their family medicine mandate? a qualitative study among family physicians and their colleagues. BMC Fam Pract. 2012;13:32. 4. Nthumba PM. “Blitz surgery:” redefining surgical needs, training, and practice in sub-Saharan Africa. World J Surg. 2010;34(3):433-437.
JAMA Surgery March 2016 Volume 151, Number 3 (Reprinted)
Copyright 2016 American Medical Association. All rights reserved.
Downloaded From: by a University of Virginia User on 10/06/2017
jamasurgery.com
necessarily represent the official position of the affiliated institutions. Dr Wren is on the Editorial Board of JAMA Surgery but was not involved in the editorial review or the decision to accept the manuscript for publication. REFERENCES
Original Investigation Research
7. Gupta S, Shrestha S, Ranjit A, et al. Conditions, preventable deaths, procedures and validation of a countrywide survey of surgical care in Nepal. Br J Surg. 2015;102(6):700-707. 8. Grimes CE, Bowman KG, Dodgion CM, Lavy CBD. Systematic review of barriers to surgical care in low-income and middle-income countries. World J Surg. 2011;35(5):941-950.
15. Luboga S, Macfarlane SB, von Schreeb J, et al; Bellagio Essential Surgery Group (BESG). Increasing access to surgical services in sub-Saharan Africa: priorities for national and international agencies recommended by the Bellagio Essential Surgery Group. PLoS Med. 2009;6(12):e1000200.
9. Groen RS, Samai M, Petroze RT, et al. Pilot testing of a population-based surgical survey tool in Sierra Leone. World J Surg. 2012;36(4):771-774.
16. Colvin M, Gumede L, Grimwade K, Maher D, Wilkinson D. Contribution of traditional healers to a rural tuberculosis control programme in Hlabisa, South Africa. Int J Tuberc Lung Dis. 2003;7(9)(suppl 1):S86-S91.
10. Gupta S, Ranjit A, Shrestha R, et al. Surgical needs of Nepal: pilot study of population based survey in Pokhara, Nepal. World J Surg. 2014;38(12): 3041-3046.
17. Homsy J, King R, Balaba D, Kabatesi D. Traditional health practitioners are key to scaling up comprehensive care for HIV/AIDS in sub-Saharan Africa. AIDS. 2004;18(12):1723-1725.
11. Surgeons OverSeas Assessment of Surgical Need (SOSAS) version 3.0. http://www .adamkushnermd.com/files/SOSAS_survey2.pdf. Accessed October 12, 2015.
18. Dovlo D. Using mid-level cadres as substitutes for internationally mobile health professionals in Africa: a desk review. Hum Resour Health. 2004;2 (1):7.
4. Bickler SW, Weiser TG, Kassebaum N, et al. Global burden of surgical conditions. Disease Control Priorities, Third Edition: Volume 1: Essential Surgery. Washington, DC: World Bank; 2015.
12. Rutherford ME, Mulholland K, Hill PC. How access to health care relates to under-five mortality in sub-Saharan Africa: systematic review. Trop Med Int Health. 2010;15(5):508-519.
19. Mock C, Acheampong F, Adjei S, Koepsell T. The effect of recall on estimation of incidence rates for injury in Ghana. Int J Epidemiol. 1999;28(4):750-755.
5. Petroze RT, Groen RS, Niyonkuru F, et al. Estimating operative disease prevalence in a low-income country: results of a nationwide population survey in Rwanda. Surgery. 2013;153(4): 457-464.
13. Norton I, von Schreeb J, Aitken P, Herard P, Lajolo C. Classification and minimum standards for foreign medical teams in sudden onset disasters. World Health Organization. http://www.who.int/hac /global_health_cluster/fmt_guidelines _september2013.pdf. Published 2013. Accessed October 7, 2015.
1. Farmer PE, Kim JY. Surgery and global health: a view from beyond the OR. World J Surg. 2008;32 (4):533-536. 2. Bae JY, Groen RS, Kushner AL. Surgery as a public health intervention: common misconceptions versus the truth. Bull World Health Organ. 2011;89(6):394. 3. Debas HT, Gosselin R, McCord C, Thind A. Surgery. In: Jamison DT, Breman JG, Measham AR, et al, eds. Disease Control Priorities in Developing Countries. 2nd ed. Washington, DC: World Bank; 2006.
6. Groen RS, Samai M, Stewart KA, et al. Untreated surgical conditions in Sierra Leone: a cluster randomised, cross-sectional, countrywide survey. Lancet. 2012;380(9847):1082-1087.
20. Meara JG, Leather AJM, Hagander L, et al. Global surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386(9993):569-624.
14. Chu K, Rosseel P, Gielis P, Ford N. Surgical task shifting in sub-Saharan Africa. PLoS Med. 2009;6 (5):e1000078.
Invited Commentary
Access to Surgical Care in Developing Countries Tarik Sammour, PhD; Andrew G. Hill, MBChB, MD, EdD(Thesis), FRACS
Universal access to good-quality surgical care is recognized as an essential component of global health.1 In this issue of JAMA Surgery, Forrester et al2 present a comparison of results from 3 separate surveys using the same tool completed by members of the general public in Nepal, Rwanda, and Sierra Leone, with a specific focus on Related article page 257 barriers to access of surgical care in these countries. The authors are to be commended for this work, which yet again demonstrates that, as in many other neighboring countries in the region, there are both unique and common geographical, financial, and societal factors that contribute to inadequate access to surgical care. It remains somewhat unclear why these specific countries were chosen for this study (which also took place during 3 different periods) and what selection bias there may have been in terms of survey responders. Nevertheless, despite any weaknesses that may exist, the study results challenge the reader and the surgical community with a recurring yet daunting question: how can access to surgery be improved in developing jamasurgery.com
countries? And for the well-meaning internationally minded surgeon, how can he or she best help to bridge these huge gaps? As identified in the Global Surgery 2030 report, 1 the basic problem can be broken into 2 major components: accessibility of surgical facilities and the availability of surgical and anesthetic professionals who can deliver that care. Based on the data from the current article, it is clear that access to primary facilities (no operating room) and secondary facilities (operating room but no surgical specialist) was not especially prohibitive in the 3 countries that were assessed. Therefore, it seems the availability of surgical (and probably anesthetic) professionals is the major barrier. One solution to this problem would be to train and educate medical staff at secondary centers in a broad range of basic anesthesia and surgical skills (such as cesarean section, basic fracture management, hernia, and abscess drainage). Programs like this have seen some success in sub-Saharan Africa with a tailor-made university training program for general/ family practitioners trained in these and other important (Reprinted) JAMA Surgery March 2016 Volume 151, Number 3
Copyright 2016 American Medical Association. All rights reserved.
Downloaded From: by a University of Virginia User on 10/06/2017
263
Evaluation Only. Created with Aspose.Pdf. Copyright 2002-2013 Aspose Pty Ltd. Research Original Investigation
Determinants of Access to Surgical Care in Developing Countries
skills.3 Such home-grown efforts are likely to be effective and sustainable, and Western partnerships with such programs are likely to be more effective than the offering of temporary
Conflict of Interest Disclosures: None reported.
ARTICLE INFORMATION Author Affiliations: Royal Adelaide Hospital, Adelaide, South Australia, Australia (Sammour); Middlemore Hospital, University of Auckland, Otahuhu, Auckland, New Zealand (Hill). Corresponding Author: Andrew G. Hill, MBChB, MD, EdD(Thesis), FRACS, University of Auckland, Ko Awatea, Middlemore Hospital, Counties Manukau Health, Private Bag 93311 Otahuhu, Auckland, New Zealand ([email protected]). Published Online: November 4, 2015. doi:10.1001/jamasurg.2015.3434.
264
surgical services led by well-meaning but ad hoc international groups, which all too often plug temporary gaps but offer few, if any, long-term gains.4
REFERENCES 1. Meara JG, Leather AJM, Hagander L, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386(9993):569-624. 2. Forrester JD, Forrester JA, Kamara TB, et al. Self-reported determinants of access to surgical care in 3 developing countries [published online November 4, 2015]. JAMA Surg. doi:10.1001 /jamasurg.2015.3431.
3. van der Voort CTM, van Kasteren G, Chege P, Dinant G-J. What challenges hamper Kenyan family physicians in pursuing their family medicine mandate? a qualitative study among family physicians and their colleagues. BMC Fam Pract. 2012;13:32. 4. Nthumba PM. “Blitz surgery:” redefining surgical needs, training, and practice in sub-Saharan Africa. World J Surg. 2010;34(3):433-437.
JAMA Surgery March 2016 Volume 151, Number 3 (Reprinted)
Copyright 2016 American Medical Association. All rights reserved.
Downloaded From: by a University of Virginia User on 10/06/2017
jamasurgery.com
