Addressing the Millennium Development Goals from a surgical perspective: essential surgery and anesthesia in 8 low- and middle-income countries.
OBJECTIVE
Surgical and anesthetic care is increasingly recognized as a neglected but cost-effective component of primary health care in low- and middle-income countries (LMICs). Strengthening delivery can help achieve Millennium Development Goals 4, 5, and 6. Large gaps in access to essential surgical care in LMICs result in considerable morbidity and mortality. The goal of this study was to provide a baseline overview of essential surgical and anesthetic capacity at district-level health facilities in multiple LMICs.


METHODS
Survey.


METHODS
District-level health facilities in multiple LMICs


METHODS
A standardized World Health Organization tool was used at selected district-level hospitals to assess infrastructure, supplies, and procedures relating to essential surgical and anesthetic capacity. The analysis included facilities from countries that assessed more than 5 health facilities. All data were aggregated and blinded to avoid intercountry comparisons.


RESULTS
Data from 132 facilities were analyzed from 8 countries: Democratic Socialist Republic of Sri Lanka (n = 32), Mongolia (n = 31), United Republic of Tanzania (n = 25), Islamic State of Afghanistan (n = 13), Republic of Sierra Leone (n = 11), Republic of Liberia (n = 9), Republic of The Gambia (n = 6), and Democratic Republic of São Tomé and Príncipe (n = 5). Universally, facilities demonstrated shortfalls in basic infrastructure (water, electricity, oxygen) and functioning anesthesia machines. Although 73% of facilities reported performing incision and drainage of abscesses, only 48% were capable of undertaking an appendectomy. In line with Millennium Development Goals 4, 5, and 6, only 32% of facilities performed congenital hernia repairs, 44% of facilities performed cesarean sections, and few facilities always had goggles and aprons to protect surgical health care workers from human immunodeficiency virus.


CONCLUSIONS
Enormous shortfalls in infrastructure, supplies, and procedures undertaken are common at district-level health facilities in LMICs.
Society of International Humanitarian Surgeons, Alpine, NJ 07620, USA. adamkushner@yahoo.com
Adam L
AL
Kushner
Meena N
MN
Cherian
Luc
L
Noel
David A
DA
Spiegel
Steffen
S
Groth
Carissa
C
Etienne
D000776:Anesthesiology / Q000458:organization & administration*; D003906:Developing Countries; D005160:Facility Design and Construction; D013502:General Surgery / Q000458:organization & administration*; D019538:Health Care Surveys; D006275:Health Facility Planning; D006767:Hospitals, District / Q000458:organization & administration*; D006801:Humans; D020380:Needs Assessment / Q000458:organization & administration*; D012959:Socioeconomic Factors