A geospatial analysis of two-hour surgical access to district hospitals in South Africa

Kathryn M Chu,Angela J Dell,Stephanie Van Straten,Harry Moultrie,Candy Day,Megan Naidoo,Sarah Rayne

doi:10.1186/s12913-020-05637-0

Abstract

BackgroundIn a robust health care system, at least 80% of a country’s population should be able to access a district hospital that provides surgical care within 2 hours. The objective was to identify the proportion of the population living within 2 hours of a district hospital with surgical capacity in South Africa.MethodsAll government hospitals in the country were identified. Surgical district hospitals were defined as district hospitals with a surgical provider, a functional operating theatre, and the provision of at least one caesarean section annually. The proportion of the population within two-hour access was estimated using service area methods.ResultsNinety-eight percent of the population had two-hour access to any government hospital in South Africa. One hundred and thirty-eight of 240 (58%) district hospitals had surgical capacity and 86% of the population had two-hour access to these facilities.ConclusionImproving equitable surgical access is urgently needed in sub-Saharan Africa. This study demonstrated that in South Africa, just over half of district hospitals had surgical capacity but more than 80% of the population had two-hour access to these facilities. Strengthening district hospital surgical capacity is an international mandate and needed to improve access.

Highlights

In a robust health care system, at least 80% of a country’s population should be able to access a district hospital that provides surgical care within 2 hours
The first indicator is the proportion of a population that lives within 2 hours of a facility that provides the bellwether procedures, which are used by the Lancet Commission on Global Surgery (LCGS) as a proxy for surgical capacity [1]
84% of the population relies on the public health care system [4], which is organized around primary health care clinics (PHC) and community health centers (CHC)

Summary

Introduction

In a robust health care system, at least 80% of a country’s population should be able to access a district hospital that provides surgical care within 2 hours. The objective was to identify the proportion of the population living within 2 hours of a district hospital with surgical capacity in South Africa. The first indicator is the proportion of a population that lives within 2 hours of a facility that provides the bellwether procedures (caesarean section, laparotomy, and treatment of an open fracture), which are used by the LCGS as a proxy for surgical capacity [1]. PHC and CHC refer patients to district, regional and tertiary hospitals for higher levels of care [5]. The government surgical services are highly variable in terms of capacity and output and only employ 42% of general surgeons

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Discussion

Conclusion