PowerPoint Presentation

Traumatic Disparities: Surgical Disease and the Great DivergenceJune 2014

VisionUniversal access to safe, affordable surgical and anesthesia care when needed UHCHealth EquityLCoGS MissionRaise global surgery within the international agendaPrioritize surgery within national policyImprove surgical care delivery (access/quality/safety)All with a goal of achieving our visionStakeholders/Audience:For whom are we responsible?Stakeholders/Audience:For whom are we responsible?VisionUniversal access to safe, affordable surgical and anesthesia care when needed UHCHealth EquityStakeholders/AudienceStakeholders/AudienceStakeholders/AudienceRecommendationsn = 37Government/MOH/MOF42Int organizations WHO, UN, USAID, WB35Colleges and Professional Societies21Foundations (Gates, etc.)/Big Donors16Patients4NGO4Community Health Workers1President and Presidents wife1Facility Managers, Clinicians1NIH/Similar HIC Institutes1Stakeholders:RecommendationsSample SuggestionsWHO/International OrganizationsInclude universal access to safe surgery in global health agendaCollect and share data on metrics identifiedListen to, support LMICs based on local needsPressure govts to improve surgerySurgery as key component of UHCFoundations/Big DonorsDirect money into research, programmatic support and infrastructureFund programs that build capacity and focus on health system strengtheningCreate a global surgical fund to support capability enhancement, system strengthening, and research Government/MOH/MOFInclude access to basic life-saving surgical care within national health plans. Invest in human resources necessary for providing surgical/anesthesia servicesFinancial protection for poor patients undergoing surgeryProvide funding for surgical services Colleges/Professional SocietiesLocally based surgical educationTrain surgeons in a way that meets population needsAdvise govts on how to improve existing facilitiesSupport task sharing when requested by LMICs11Traumatic Disparities: Surgical Disease and the Great DivergenceJune 2014

Key MessagesSurgery is an indivisible, indispensible component of a properly functioning health system, UHC and SDGs, with the ultimate goal of health care equityTraumaCancerInvestments in surgery are pro growth, cost effective and have a positive return on investmentHow can we improve the situation?How can it be paid for?Key Messagesn = 46 1. Rights/equity (Farmer resolution): 5 billion people do not have access to safe affordable surgical and anesthesia care when needed70%2. Structure/process (Jim Kim resolution): Surgery is an indivisible, indispensible component of a properly functioning health system85%3. Governance/management (Eva Hanciles resolution): Huge gains in surgical care provision are possible with already existing health care systems by employing proper governance and management principles and training processes40%4. Economic (Yamey/Conteh/Yip resolution): Investments in surgery are pro growth, cost effective, have a positive ROI etc63%Key Messages Other Messages:Access to surgical care should be a universal human right. Lack of surgical provision leads to an equity issue.Appropriate training is essential to achieve global surgery. Start with attention in trauma. When you have a good team to this attention, I think the surgical system works alone.Safe and effective surgical care is the foundation of a functioning, strengthened health system.Traumatic Disparities: Surgical Disease and the Great DivergenceJune 2014

Metricsn = 411. Proximity: Percent of population within 2 hours to a facility capable of safe emergency surgery71%2. Timeliness: Emergency surgery performed within 24 hours73%3. Workforce: Trained providers per population83%4. Throughput: Procedure rate per population66%5. Elective to emergency procedure ratio44%6. Capacity: Percent of district-level hospitals meeting requirements for safe surgery78%7. Outcomes: Peri-Operative Mortality Rate (all procedures or bellwether)83%8. Financial Protection: Percent of population falling into poverty or incurring catastrophic expenditure due to out-of-pocket healthcare expenditure73%9. Mixed: Unmet need for surgical care63%10. Strategic Planning: Inclusion of surgery within national or regional health plans83%MetricsOther Metrics:ASA ClassMetric on blood and oxygen availability (units of blood collected? availability of blood and oxygen with urban/rural distribution?) Is there any measurement of safe referral system? Coverage (met need/unmet need)

Requirements for Safe Surgeryn = 311. Staff: A trained surgical provider and team100%2. Staff: A trained anesthesia provider and team97%3. Staff: Postop nursing care, and physiological observations94%4. Staff: 24/7 surgical cover to review & assess patients81%5. Stuff: Equipment, supplies, consumables, antibiotics and pain meds100%6. Stuff: Equipment maintenance94%7. Stuff: Sterilization capability100%8. Stuff: Screened and cross-matched blood78%9. Stuff/Staff protection: Gloves, and the ability to test for HIV87%10. Process: Safe surgery checklist *47%11. Process: Preoperative risk assessment and operation planning59%Requirements for Safe SurgeryOther Metrics:Quality and delivery monitoring and feedback mechanism/audit processBasic diagnosticsAspirational: PathologyMorbidity and mortality Minimal lab tests and imageryDiagnosticsHygiene of the hospital settingAbility to refer to a higher level of care via efficient transport systemAccess to support and mentorship (e.g. more senior surgeon)Performing surgery within established guidelines

Future Research Agendan = 28Research AreasImplementation15Workforce14Quality12Barriers to access/care8Cost of care delivery7Access7Burden6Other6Benchmarking4Patient experience3Safety128 individual responses82 research suggestions21Future Research AgendaSample SuggestionsImplementationHealth system design and operational researchWhat are the optimal methods to deliver surgical care to a broad population quickly and effectively? Private practice model vs. public? Research on how to improve systems for delivery of care and supply chain challengesWorkforceWorkforce training, distribution and retentionBenefits and disadvantages of task shiftingWhat are the key incentives to optimize retention and function of a workforce in a low-income environment?QualityIdentify quality issues that cut across all groups of surgery that can be used as a metric and for progress monitoringQuality of surgical services: all three aspects of Donabedian Framework (structure, process, outcomes)FinancingFinancing: What proportion of GDP (both local and foreign) goes to surgical spending?Capacity development: Impact of integrative capacity development on services 22Traumatic Disparities: Surgical Disease and the Great DivergenceJune 2014

Items requiring consensus