title: Quantifying surgical and anesthetic availability at primary health facilities in Mongolia.
abstract: BACKGROUND
  Significant barriers limit the safe and timely provision of surgical and anaesthetic care in low- and middle-income countries. Nearly one-half of Mongolia's population resides in rural areas where the austere geography makes travel for adequate surgical care very difficult. Our goal was to characterize the availability of surgical and anaesthetic services, in terms of infrastructure capability, physical resources (supplies and equipment), and human resources for health at primary level health facilities in Mongolia.
  
  
  METHODS
  A situational analysis of the capacity to deliver emergency and essential surgical care (EESC) was performed in a nonrandom sample of 44 primary health facilities throughout Mongolia.
  
  
  RESULTS
  Significant shortfalls were noted in the capacity to deliver surgical and anesthetic services. Deficiencies in infrastructure and supplies were common, and there were no trained surgeons or anaesthesiologists at any of the health facilities sampled. Most procedures were performed by general doctors and paraprofessionals, and occasionally visiting surgeons from higher levels of the health system. While basic interventions such as suturing or abscess drainage were commonly performed, the availability of many essential interventions was absent at a significant number of facilities.
  
  
  CONCLUSIONS
  This situational analysis of the availability of essential surgical and anesthetic services identified significant deficiencies in infrastructure, supplies, and equipment, as well as a lack of human resources at the primary referral level facilities in Mongolia. Given the significant travel distances to secondary level facilities for the majority of the rural population, there is an urgent need to strengthen the delivery of essential surgical and anaesthetic services at the primary referral level (soum and intersoum). This will require a multidisciplinary, multi-sectoral effort aimed to improve infrastructure, procure and maintain essential equipment and supplies, and train appropriate health professionals.
authors.affiliation: Division of Orthopaedic Surgery, Childrens Hospital of Philadelphia, 2nd Floor Wood Building, 34th Street and Civic Center Blvd, Philadelphia, PA 19104, USA. spiegeld@email.chop.edu
authors.forename: David A
authors.initials: DA
authors.lastname: Spiegel
authors.forename: Shelly
authors.initials: S
authors.lastname: Choo
authors.forename: Meena
authors.initials: M
authors.lastname: Cherian
authors.forename: Sergelen
authors.initials: S
authors.lastname: Orgoi
authors.forename: Beat
authors.initials: B
authors.lastname: Kehrer
authors.forename: Raymond R
authors.initials: RR
authors.lastname: Price
authors.forename: Salik
authors.initials: S
authors.lastname: Govind
mesh_terms: D000758:Anesthesia / Q000706:statistics & numerical data*; D006268:Health Facilities / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008986:Mongolia; D011320:Primary Health Care / Q000706:statistics & numerical data*; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D000078329:Workforce