International health care capacity: 2 billion people lack access to basic surgery

4626759807_ab19de35f1_bGlobal disparities in health outcomes and health care capacity are no surprise, but researchers have recently begun to quantify the magnitude of the global disparity in access to basic surgical care. The figures are truly staggering.

After analyzing information on 769 hospitals in 92 countries that are part of the World Health Organization’s Safe Surgery Saves Lives campaign, researchers from Harvard University’s school of public health concluded that over 2 billion people lack access to the most basic forms of surgical care. Predictably, this deficit in health care capacity is profoundly acute in poorer nations (with possible overabundance in wealthier nations.)

Worldwide there’re an estimated 234 million surgeries done each year, 75% are performed among the wealthiest 3rd and 4% among the poorest third of the world’s population. Ironically it’s the poorest third that have the greater need for such health care procedures. While high-income regions have a minimum of 14 operating facilities per 100,000 population, low-income areas have less than 2 per 100,000. Even when surgery is performed in poorer regions, it often lacks the most basic hardware, such as pulse oximetry (a device that usually clips to your finger and measures the amount of oxygen in your blood.) Available in more than 99% of surgical theatres in wealthier nations, pulse oximtry is absent from almost 20% of surgeries done worldwide, and 50% of those performed in poorer nations. That amounts to some 32 million procedures performed each year that lack this most basic standard of care. (Surgical quality pulse oximetry devices cost around US$1200, though basic portable units are available for under $100.)

Basic surgical care is not only a standard part of a health care system, but also fundamental for addressing public health concerns such as maternal and child mortality. Naturally, a functional surgical theatre in a small regional hospital or health center can address multiple public health problems at once: From emergency cesarean section (lack of which is a major cause of maternal and neonatal death), to small animal bites, to road accidents (a major killer around the world.) The costs involved in outfitting a surgical theatre to perform basic procedures is incredibly low, and one surgical theatre may provide health care to a large geographic area. International Health Professor Deborah Maine from Boston University places a price tag of around $10,000 per theatre.

Innovative opportunities and organizations also exist to direct recycled or older- but still perfectly functional- equipment from health care facilities that no longer need them or have upgraded, to those who lack them altogether.

Photo credit: The author

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