A Comparative Analysis of the Health, Financial, Distributive, and Cost-Effectiveness Impacts of Maxillofacial Surgery in Guinea

Abstract

Background: Non-governmental organizations (NGOs) play a substantive role in the delivery of surgical services in in low- and middle-income countries (LMICs). Assessment of their outcomes, especially as they relate to outcomes of surgery done in country, remains limited. Methods: A prospective analysis of maxillofacial surgery in Guinea. Outcomes of interest were changes in patient health, subjective well-being, and financial status; hardship financing and catastrophic expenditure; equitable distribution of surgical access; and cost-effectiveness. Results: We followed 569 patients requiring maxillofacial surgery in Conakry, Guinea, 114 of whom got care at local university hospitals, and 455 of whom got their care with Mercy Ships, a surgical NGO. Patients were followed for between three months (local) and one year (NGO). All patients reported significant improvement in objective and subjective measures of health and in financial status. Approximately half had to borrow and sell to get care, with NGO patients borrowing less, on average. However, NGO patients faced more risk of catastrophic expenditure (41.2% vs. 28.1%, p < 0.001). NGO patients were significantly poorer, whether financial status was measured by asset wealth or monthly income (p < 0.001). Finally, surgical care by the NGO was cost effective. Conclusions: In a prospective analysis of surgical patients in an LMIC, we find that surgery improves health and financial well-being. NGOs may be able to reach patients who would not be able to get care through their local system; however, this comes at a cost of increased initial financial risk. Finally, NGO-based surgical care is cost-effective. Funding Information: Funding for this study was supplied by Mercy Ships. Declaration of Interests: MGS receives funding from the Iris O'Brien Foundation. MGS is on the board for Pharos Global Health Advisors. PEL is the International Chief Medical Officer of, and MH and DA are employed by Mercy Ships. No other authors have anything to declare. Ethics Approval Statement: This study was approved by the Partners Health System IRB and by the Mercy Ships Research Ethics Council. Consent was obtained in the patient’s local language. If patients were children, their parents were asked to participate.