title: Mapping Disparities in Access to Safe, Timely, and Essential Surgical Care in Zambia.
abstract: Surgical care is widely unavailable in developing countries; advocates recommend that countries evaluate and report on access to surgical care to improve availability and aid health planners in decision making.
  
  
  
  To analyze the infrastructure, capacity, and availability of surgical care in Zambia to inform health policy priorities.
  
  
  
  In this observational study, all hospitals providing surgical care were identified in cooperation with the Zambian Ministry of Health. On-site data collection was conducted from February 1 through August 30, 2011, with an adapted World Health Organization Global Initiative for Emergency and Essential Surgical Care survey. Data collection at each facility included interviews with hospital personnel and assessment of material resources. Data were geocoded and analyzed in a data visualization platform from March 1 to December 1, 2015. We analyzed time and distance to surgical services, as well as the proportion of the population living within 2 hours from a facility providing surgical care.
  
  
  
  Surgical capacity, supplies, human resources, and infrastructure at each surgical facility, as well as the population living within 2 hours from a hospital providing surgical care.
  
  
  
  Data were collected from all 103 surgical facilities identified as providing surgical care. When including all surgical facilities (regardless of human resources and supplies), 14.9% of the population (2 166 460 of 14 500 000 people) lived more than 2 hours from surgical care. However, only 17 hospitals (16.5%) met the World Health Organization minimum standards of surgical safety; when limiting the analysis to these hospitals, 65.9% of the population (9 552 780 people) lived in an area that was more than 2 hours from a surgical facility. Geographic analysis of emergency and essential surgical care, defined as access to trauma care, obstetric care, and care of common abdominal emergencies, found that 80.7% of the population (11 704 700 people) lived in an area that was more than 2 hours from these surgical facilities.
  
  
  
  A large proportion of the population in Zambia does not have access to safe and timely surgical care; this percentage would change substantially if all surgical hospitals were adequately resourced. Geospatial visualization tools assist in the evaluation of surgical infrastructure in Zambia and can identify key areas for improvement.
authors: Division of General Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California.
authors: Micaela M
authors: MM
authors: Esquivel
authors: Division of General Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California.
authors: Tarsicio
authors: T
authors: Uribe-Leitz
authors: Permanent Mission of Zambia, Geneva, Switzerland.
authors: Emmanuel
authors: E
authors: Makasa
authors: Zambian Ministry of Health, Lusaka, Zambia.
authors: Kennedy
authors: K
authors: Lishimpi
authors: Zambian Ministry of Health, Lusaka, Zambia.
authors: Peter
authors: P
authors: Mwaba
authors: Division of Pediatric General and Thoracic Surgery, Department of Surgery, Children's Hospital of Wisconsin, Milwaukee.
authors: Kendra
authors: K
authors: Bowman
authors: Division of General Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California.
authors: Thomas G
authors: TG
authors: Weiser
mesh_terms: D000005:Abdomen / Q000601:surgery; D003906:Developing Countries / Q000706:statistics & numerical data*; D004865:Equipment and Supplies, Hospital / Q000600:supply & distribution*; D062305:Geographic Mapping; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006761:Hospitals / Q000592:standards; D006801:Humans; D009774:Obstetrics; D061214:Patient Safety; D013514:Surgical Procedures, Operative; D011795:Surveys and Questionnaires; D013997:Time Factors; D000078329:Workforce; D014947:Wounds and Injuries / Q000601:surgery; D015024:Zambia