Global Burden Of Surgical Disease Research Articles

144. The Role of Plastic Surgery in Addressing the Global Burden of Disease: Plastic Surgery and the Sustainable Development Goals

PURPOSE: Surgical conditions account for nearly one-third of the global burden of disease. Plastic surgeons play a vital role in treating many of these conditions, including congenital deformities, wound care, acute burn care and reconstruction, traumatic injuries, and oncologic reconstruction. We examine the role of plastic surgeons in addressing the sustainable development goals (SDGs), a 17-part call to action adopted by the United Nations. METHODS: We reviewed each of the 170 subgoals of the 17 SDGs and analyzed them for relevance to plastic surgery. We conducted a literature review to identify evidence of how plastic surgery supports each subgoal and SDG. RESULTS: Plastic surgical interventions can advance 50 of the 170 (28%) subgoals and 11 of the 17 SDGs (65%). Most applications were evident in SDG 3: “Ensure healthy lives and promote well-being for all at all ages.” Examples of plastic surgery applications in the SDGs include reconstructive efforts for congenital anomalies, traumatic and accidental injuries, such as road traffic accidents, encouragement of smoking cessation, and mitigating mortality and morbidity from environmental and chemical exposures. CONCLUSION: Our study identifies the meaningful and unique ways that plastic surgery can advance the SDGs and address the global burden of surgical disease. This supports the integration of plastic surgery into broader public health efforts to build surgical capacity.

A cost-effectiveness analysis of surgical care delivery in Eastern Uganda-a societal perspective

BackgroundThe mismatch between the global burden of surgical disease and global health funding for surgical illness exacerbates disparities in surgical care access worldwide. Amidst competing priorities, governments need to rationally allocate scarce resources to address local needs. To build an investment case for surgery, economic data on surgical care delivery is needed. This study focuses on femur fractures.MethodsThis prospective cohort study at Soroti Regional Referral Hospital (SRRH), captured demographic, clinical, and cost data from all surgical inpatients and their caregivers at SRRH from February 2018 through July 2019. We performed descriptive and inferential analyses. We estimated the cost effectiveness of intramedullary nailing relative to traction for femur fractures by using primary data and making extrapolations using regional data.ResultsAmong the 546 patients, 111 (20.3%) had femur fractures and their median [IQR] length of hospitalization was 27 days [14, 36 days]. The total societal cost and Quality Adjusted Life Year (QALY) gained was USD 61,748.10 and 78.81 for femur traction and USD 23,809 and 85.47 for intramedullary nailing. Intramedullary nailing was dominant over traction of femur fractures with an Incremental Cost Effectiveness Ratio of USD 5,681.75 per QALY gained.ConclusionFemur fractures are the most prevalent and most expensive surgical condition at SRRH. Relative to intramedullary nailing, the use of femur traction at SRRH is not cost effective. There is a need to explore and adopt more cost-effective approaches like internal fixation.

Academic Global Surgery: Creating Opportunities, Equity, and Diversity.

A workforce trained in the development and delivery of equitable surgical care is critical in reducing the global burden of surgical disease. Academic global surgery aims to address the present inequities through collaborative partnerships that foster research, education, advocacy and training to support and increase the surgical capacity in settings with limited resources. Barriers include a deficiency of resources, personnel, equipment, and funding, a lack of communication, and geographical challenges. Multi-level partnerships remain fundamental; these types of partnerships include a wide range of trainees, professionals, institutions, and nations, yet care must be taken to avoid falling into the trap of surgical "voluntourism" and undermining the expertise and practice of long-standing frontline providers. Academic global surgery has the benefit of developing a community of surgeons who possess the tools needed to collaborate on individual, institutional, and international levels to address inequities in surgery that are spread variously across the globe. However, challenges for surgeons pursuing a career in global surgery include balancing clinical responsibilities while integrating global surgery as a career during training. This is due in part to the lack of mentorship, research time, grant funding, support to attend conferences, and a limitation of resources, all of which are significantly more pronounced for surgeons from low-resource countries.

Access to Health Services Among Forced Migrants in Tanzania: A Cluster Randomized Cross Sectional Study of 3560 Congolese and Burundian Refugees.

Despite significant advances in the understanding of the global burden of surgical disease, limited research focuses on access to health and surgical services among refugees, especially in east Africa. The goal of this study was to describe patterns of access to transportation to health services among Congolese and Burundian refugees in Tanzania. We utilized cluster random sampling to perform a large, cross-sectional study in Nyarugusu refugee camp, Tanzania using an adapted version of the Surgeon Overseas Assessment Tool (SOSAS). We randomly selected 132 clusters out of 1472 clusters, randomly selected two people from all households in those clusters. Data analysis was performed in STATA (Stata Version 16, College Station, TX). A total of 3560 participants were included in the study including 1863 Congolese refugees and 1697 Burundian refugees. The majority of refugees reported they were generally healthy (n = 2792, 79.3%). The most common period of waiting to be seen at the health center was between three and 5 h (n = 1502, 45.8%), and over half of all refugees waited between 3 and 12 h to be seen. There was heterogeneity in other intra-camp referral networks (e.g. to and from traditional healer and hospital). Finally, a low percentage (3%) of participants reported leaving the refugee camp to seek health care elsewhere, and Congolese refugees were more likely to pursue self-referral in this manner. To our knowledge, this is the largest study focused on access to transportation among refugees in Tanzania and sub-Saharan Africa. Most participants reported financial difficulty always affording transportation costs with significant wait times occurring once arrived at the hospital. Our study does suggest that some independent health care seeking did occur outside of the camp-based services. Future research may focus more specifically on barriers to timely servicing of patients and patterns of self-referral.Please confirm if the author names are presented accurately and in the correct sequence (given name, middle name/initial, family name). Author 1 Given name: [Zachary Obinna] Last Name [Enumah] and Author 2 Given name: [Mohamed Yunus] Last Name [Rafiq]. Also, kindly confirm the details in the metadata are correct.Confirmed.

Global Surgery: advent of a new discipline

Global surgery is a rapidly developing multidisciplinary field, aiming to provide equitable and improved surgical care across international health systems often with a focus on underserved populations of low- and middle-income countries1. History is witness that Christian Missionaries, International Committee of the Red Cross, Aga Khan Foundation and Islamic Association of North America have been offering humanitarian health support, including Surgery, to the needy since long. These were joined by League of Nations Health Organization (since 1920; later became the World Health Organization in 1946) and Médecins Sans Frontières (since 1971)2. However, Surgery remained ‘The neglected stepchild of global health’3. Main reason for this was lack of data leading to knowledge gap about the magnitude of the problem. The much needed catalyst for development of Global Surgery was the launch of Lancet Commission on Global Surgery report in January 20144. This report provided the much needed data about unmet needs of Surgery which grabbed the World’s attention: 5 billion people not having access to safe, timely affordable surgery and anaesthesia; leading to 18.6 million preventable early deaths each year - more than the number of people who die from HIV/AIDS, malaria and tuberculosis combined; millions of patients facing catastrophic expenditures when faced with surgical costs and many low- and middle-income countries likely to lose up to 2% of GDP due to loss of proper surgical care leading to loss of productivity. They also predicted that to reach the necessary levels of access to surgery by 2030 would require an investment of $420 billion, which would save an estimated $12 trillion in lost GDP over the same period, making it a very sound investment. And global burden of surgical disease was estimated to be ~ 30%5.

The need for craniofacial trauma and oncologic reconstruction in global surgery

The global burden of surgical disease is concentrated in low- and middle-income countries and primarily consists of injuries and malignancies. While global reconstructive surgery has a long and well-established history, efforts thus far have been focused on addressing congenital anomalies. Craniofacial trauma and oncologic reconstruction are comparatively neglected despite their higher prevalence. This review explores the burden, management, and treatment gaps of craniofacial trauma and head and neck cancer reconstruction in low-resource settings. We also highlight successful alternative treatments used in low-resource settings and pearls that can be learned from these areas.

Head and neck surgery global outreach: Ethics, planning, and impact

BackgroundHead and neck surgical oncology and reconstruction are uniquely suited to address burdens of disease in underserved areas. Since these efforts are not well known in our specialty, we sought to understand global outreach throughout our society of surgeons.MethodsSurvey distributed to members of the American Head and Neck Surgery involved in international humanitarian head and neck surgical outreach trips.ResultsThirty surgeons reported an average of seven trips to over 70 destinations. Identification of candidates, finances, on‐site patient care, complications, long‐term post‐surgical care, ethics, and educational goals are reported. We report a success rate of 90% on 125 free flaps performed in these settings.ConclusionsThe effort to answer the call for alleviating the global burden of surgical disease is strong within our specialty. There is a shared focus on humanitarian effort and teaching. Ethics of high resource surgeries such as free flap reconstruction remains controversial.

Prevalence of untreated surgical conditions in bateys (Sugar Workers’ Towns) of the Eastern Dominican Republic: a retrospective cross-sectional study

Introduction: The global burden of surgical disease is likely immense, but surgical care has been largely neglected in low- and middle-income countries, partly due to a lack of region-specific evidence describing the prevalence. In preparation for the opening of a charitable surgical center, the organization One World Surgery conducted a census, needs assessment, and a series of charitable outreach primary care clinics in several bateys (sugar workers’ towns) in the eastern Dominican Republic. This study aims to use information collected by the organization to determine the prevalence of untreated surgical conditions in an underserved region of a high-middle-income country. Methods: Population data from a series of bateys surrounding the city of San Pedro de Macoris on the country’s eastern plains, a region with significant sugarcane, was determined from a census and needs assessment performed by community health workers between April and December 2019. This information was used to invite patients to charitable outreach primary care clinics led by volunteer US-based physicians between September 2019 and February 2020, during which the number of patients with untreated surgical conditions was calculated. Results: Volunteer physicians recommended at least 1 surgery for 147 individuals among a population of 4070 (3.61%). Fifty-two percent of surgical patients were male and 36.7% were age 60 and above. The most common surgical diagnoses were cataract, pterygium, and hernias/hydroceles. The most needed specialties were ophthalmology (1.74%), general surgery (1.01%), and orthopedics (0.69%). Conclusion: The population of bateys (sugar workers’ towns) in the eastern Dominican Republic, a high-middle-income country, has a high prevalence of untreated surgical disease. This is likely due partly to the population of the bateys being underserved compared to the country overall, and partly to the country’s increasing life expectancy. However, since most patients with untreated surgical conditions are of working age or below, it will be important with respect to national productivity for the Dominican Republic and other high-middle-income countries to increase surgical capacity along with other more traditionally prioritized health care initiatives.

Universal access to safe, affordable, timely surgical and anaesthetic care in Papua New Guinea: the six global health indicators.

The unmet global burden of surgical disease is substantial. The Lancet Commission on Global Surgery (LCoGS) estimated that 5 billion people do not have access to safe, affordable and timely surgical care, with 80% of those without access living in low- and middle-income countries. The Milne Bay Province (pop 331 000) of Papua New Guinea, with an archipelago of islands up to 750 km from its capital, Alotau, has only one hospital capable of performing Caesarean Section, Emergency Laparotomy and managing an open fracture, the three Bellwether procedures. This paper aims to report the six Lancet Commission on Global Surgery metrics for Milne Bay Province. The study was conducted between January and August 2019. Bellwether access was investigated by a prospective study on 115 patients presenting to hospital. The surgical, anaesthesia and obstetric (SAO) workforce, surgical volume and perioperative mortality rate, were calculated for 2012-2018 from hospital records and operation registers. Financial risk metrics were calculated by surveying 50 patients at discharge from hospital. Bellwether access: Only 27.8% (n = 32) of the study population (n = 115) experienced less than 2-hours second delay (journey time to hospital). The average SAO provider density was 1.8 per 100 000 population. There were 606 procedures performed per 100 000 with a mean annual perioperative mortality rate of 0.3%. Catastrophic expenditure is a risk for 29% of the population. Milne Bay Province can perform surgery safely, but there is limited access to timely surgical care when needed with a significant proportion put at financial risk by requiring it.

Oral and Maxillofacial Surgery in Low-Income and Middle-Income Countries.

Five billion people worldwide do not have access to safe, affordable surgical and anesthesia care. The burden of inadequate access to safe and affordable surgical care falls heaviest on individuals living in low-income and middle-income countries (LMIC), where 9 out of 10 people do not have access to basic surgical care. Global oral and maxillofacial surgical care is included in the global burden of surgical disease, and increased awareness of the need for global oral and maxillofacial surgery (OMS), with the initiation, support, and funding of research on the need to develop a global OMS capacity-building strategy is imperative.

Abstract 14: Going the Distance: A Cross Sectional Study of Embedded Surgical Training Experiences in Low-to-Middle Income Countries

Background: Trainees and young surgeons increasingly seek to understand and help address the global burden of surgical disease in low-to-middle income countries (LMICs). Time, program and funding constraints often limit these experiences to 1-2 weeks. However, some surgical trainees and recent graduates have embarked upon longer-term “embedded” global surgery experiences of ≥3 months. There is high potential value in these longer-term experiences, but their common characteristics and significance have not been examined. This study seeks to describe common features of such experiences, their impact on trainees’ learning, and the degree to which they have fostered local partnerships, scholarly achievement, and competency development. Methods: A cross-sectional sample of surgical trainees and recent surgical graduates was surveyed with 25 close- and open-ended questions concerning experience characteristics, self-perceived value, local impact, and professional and scholarly value. Advancement in ACGME competencies during the experience was assessed on a likert scale (1-5) relative to an average year of plastic surgical residency (3). Results: Five young surgeons described experiences that took place in Uganda, India and Nicaragua of average duration 1.8 years (1-2 years). Trainee roles were primarily research-related, graduate roles were a clinical and research hybrid. Resident year at time of experience were ≤PGY4. Funding sources were NGO employment 3/5(80%), grants 2/5(40%), scholarships 1/5(20%), self 1/5(20%). 4/5 (80%) responders found this opportunity via a home institution connection. Top facilitating factors were prior relationships and local mentor support. Top impeding factors were political factors causing delays and cultural/language differences. Aspects that most commonly made the experience valuable to local partners and health systems were serving as additional personnel/resources and establishing self-sufficient processes/policies/partnerships. Scholarly output consisted of scientific presentations (24.4±32.2) and scientific manuscripts (7.8±10.1). ACGME competency growth exceeded that of an average residency year in all domains: interpersonal and communication skills (4.8±0.4), systems-based practice (4.6±0.5), professionalism (4.4±0.5), practice-based learning and improvement (4.4±0.9), medical knowledge (4±0.7), patient care (4±1). Top recommendations were regarding personal attitude and finding a local mentor organization/surgeon. Conclusion: Embedded surgical training experiences in LMICs fostered a high-degree of local health system understanding, ACGME competency acquisition, scholarly output, and enrichment of international partnerships.

Retention and Migration of Rwandan Anesthesiologists: A Qualitative Study.

Health care professional migration continues to challenge countries where the lack of surgical and anesthesia specialists results in being unable to address the global burden of surgical disease in their populations. Medical migration is particularly damaging to health care systems that are just beginning to scale up capacity building of human resources for health. Anesthesiologists are scarce in low-resource settings. Defining reasons why anesthesiologists leave their country of training through in-depth interviews may provide guidance to policy makers and academic organizations on how to retain valuable health professionals. There were 24 anesthesiologists eligible to participate in this qualitative interview study, 15 of whom are currently practicing in Rwanda and 9 had left the country. From the eligible group, interviews were conducted with 13 currently practicing in Rwanda and 2 who had left to practice elsewhere. In-depth interviews of approximately 60 minutes were used to define themes influencing retention and migration among anesthesiologists in Rwanda. Interviews were conducted using a semistructured guide and continued until theoretical sufficiency was reached. Thematic analysis was done by 4 members of the research team using open coding to inductively identify themes. Interpretation of results used the framework categorizing themes into push, pull, stick, and stay to describe factors that influence migration, or the potential for migration, of anesthesiologists in Rwanda. While adequate salary is essential to retention of anesthesiologists in Rwanda, other factors such as lack of equipment and medication for safe anesthesia, isolation, and demoralization are strong push factors. Conversely, a rich academic life and optimism for the future encourage anesthesiologists to stay. Our study suggests that better clinical resources and equipment, a more supportive community of practice, and advocacy by mentors and academic partners could encourage more staff anesthesiologists to stay and work in Rwanda.

Surgical Training Throughout Africa: A Review of Operative Case Volumes at Multiple Training Centers.

Adequate surgical training is paramount to produce competent surgeons to address the global burden of surgical disease. The Pan-African Academy of Christian Surgeons (PAACS) has general surgery training programs in eight countries. Operative case volumes have been positively associated with improved trainee performance and patient outcomes. For certification in the USA, 850 total operations are required from defined case categories. Yet, little is known about the operative experience of surgical trainees throughout Africa. Operative procedures were reviewed, categorized, and validated from a cohort of PAACS graduates and compared to graduates from Accreditation Council for Graduate Medical Education (ACGME) programs. The primary and secondary outcomes were total case volumes and cases within ACGME-defined categories. Regional variations were explored. Twenty PAACS trainees, from five programs in four countries, performed 38,267 unique procedures. ACGME reports on 1211 residents from 251 programs. PAACS graduates logged more major cases (median 1448) than ACGME graduates (median 993) (p value = 0·0001). PAACS graduates performed more gynecology and obstetrics, orthopedics, head and neck, urology, endocrine, operative trauma, pediatric surgery, plastic surgery, and skin and soft tissue cases. US graduates performed more cases in abdomen, alimentary tract, breast, thoracic, and vascular categories. Comparison between regions demonstrated volume and category variations between Kenya and Gabon, Ethiopia, and Cameroon. PAACS trainees perform more operations than ACGME trainees with differences in distribution. This experience can serve as a model for regional educational programs seeking to address the broad and largely unmet burden of surgical disease.

Long-Term Follow-Up of Humanitarian Surgeries: Outcomes and Patient Satisfaction in Rural Ghana

BackgroundNongovernmental organizations conduct short-term surgical outreach to lessen the substantial global burden of surgical disease. Long-term outcomes of short-term surgical missions (STSMs) are underreported, raising concern for clinical sequelae and patient satisfaction with essential general surgeries. This study aims to describe long-term follow-up results of one general surgical nongovernmental organization's provision of care in rural Ghana with focus on patient-related outcomes and satisfaction. MethodsFrom 2013 to 2018, Tetteh Quarshie Memorial Hospital in Mampong, Ghana, was the host site of annual 1-wk International Surgical Health Initiative (ISHI) STSMs. Beginning in 2016, an ISHI provider-hosted follow-up clinics augmented by mobile telephone support. Surgical patients from 2013 to 2016 were contacted by the local nursing staff and evaluated for long-term outcomes and self-reported satisfaction. ResultsSixty-nine of 256 patients (27%) responded; 39 patients (57%) were interviewed and examined by an ISHI physician, whereas 30 patients (43%) received mobile telephone follow-up. Mean age was 47 (±18) y, with 44% female patients, and mean duration of follow-up was 1.5 (±1) y. Eleven patients (16%) had surgical and anesthesia complications. All patients reported improvement in symptoms and activity level. Eighty-six patients reported complete satisfaction (5/5). Factors associated with reduced patient satisfaction (<5/5) included increased age and complications. ConclusionsTo our knowledge, this is one of the first studies focusing on patient-reported outcomes for the evaluation of long-term follow-up of general surgery STSMs. With mobile technology, long-term follow-up is achievable toward obtaining meaningful outcomes. Complications in this series are within an acceptable range, whereas symptom improvement and overall satisfaction are high.

The Effectiveness of an International Cleft Mission Model in Asia: An Update.

Cleft lip/palate is a congenital craniofacial anomaly affecting patients physically and psychosocially and has contributed to the global burden of surgical disease, especially in underprivileged areas. For 20 years, Noordhoff Craniofacial Foundation (NCF) and the Chang Gung Craniofacial Center (CGCFC) have carried out missions to these areas. Rather than implementing short-term missions that lack proper follow-up care, the team has provided an effective, long-term, and multidisciplinary approach for the treatment of patients with cleft lip/palate. In this study, we evaluate the sustainability and effectiveness of the cleft mission model implemented by NCF and CGCFC. Data from the years 1998-2017 were retrieved from the NCF database. All local centers were evaluated by a 3-stage categorization, levels 1 to 3, based on 4 criteria: (1) capacity to carry out independent missions, (2) diversity of cleft-care professionals, (3) diversity of surgical service offered, and (4) collaboration with local hospitals. Support and training of personnel were provided based on deficiency in these criteria. Noordhoff Craniofacial Foundation made close collaborations and partnerships with several organizations that shared its mission for comprehensive cleft care in developing countries. In all, 19 partner cleft teams in 9 different countries were established. In coordination with these teams, NCF and CGCFC have treated 1846 patients across 78 mission trips. To date, 158 personnel from 19 different countries have been successfully trained to provide cleft care in local centers. Most partner cleft teams centers have progressively reached category level 3, including those in the Philippines, Cambodia, and Mongolia. In order to establish and maintain sustainable cleft care in developing regions, commitment and compassion toward those who lack essential resources are necessary. Noordhoff Craniofacial Foundation and CGCFC have achieved a successful and practicable model through seeding medical personnel in order to provide effective and sustainable cleft care to the regions in need.

Global Health Partnerships - Could They Benefit UK Maxillofacial Trainees?

Introduction/Aims: The Lancet Commission on Global Surgery has stimulated interest in embedding surgery within the global health agenda. The global burden of surgical disease is substantial and growing. Our maxillofacial department has been involved in a partnership with the maxillofacial department in Gaborone, Botswana for the past 10 years. These partnerships are mutually beneficial to both parties involved. Feedback has demonstrated that 75% of volunteers felt they developed an understanding of areas and systems outside of their usual scope of activity. Many also felt they developed their team working, resource management and other transferable skills. Data collected on our latest trip to Botswana demonstrates the potential benefit to UK trainees.

What Is the Role of Plastic Surgery in Global Health? A Review.

There is growing awareness of the substantial global burden of surgical disease. Conditions treated effectively by plastic and reconstructive procedures make a large proportion of the global surgical diseases, and disproportionately affect individuals at the lower end of the economic spectrum. This article reviews the role of plastic surgery in global health, highlights the ongoing need for plastic and reconstructive surgery globally, and increasing efforts that have been made to meet these needs. There global shortage of plastic surgeons in low and middle income countries, but plastic surgery has a long tradition of humanitarian aid, has been a leader in global surgery development. Plastic and reconstructive surgical care has increasingly been shown to be cost effective and to have an immense impact on the economy of a region, delivering a substantial return on investment. More sustainable global surgical care is essential in future, requiring ongoing efforts from the plastic surgery community, greater recognition of the problems that can be addressed at policy level, and research to help guide policy-makers when facing the decision of allocating scarce resources. There is a fundamental role of plastic surgery in global health.

The Global Burden of Surgical Disease: An Analysis on Inaccessible Surgical Care in Low and Middle Income Countries

Worldwide, 4.8 billion people do not have access to safe, adequate surgical care and anaesthetic management. Surgical care has been deemed “the neglected child of global health,” a startling reminder of the disparities in health services. The provision of surgical interventions can avert 11% of the global burden of disease and 1.5 million deaths each year. Many obstacles exist for low- and middle-income countries (LMIC) to progress towards accessible surgical care. The first challenge is delivering cost-effective surgical care despite financial constraints and political turmoil. Foreign aid was established to alleviate the financial burden and its contributions have been pivotal. However, based on the political climate in certain countries, funds are siphoned to government sectors other than health care. Moreover, the lack of infrastructure, equipment, and personnel in LMIC compound the issue. The other challenge is determining if surgery is as feasible and effective as non-surgical health interventions. Surgical care is crucial and this paper aims to assess the challenges that limit its stature in global health discussions. The paper will address the influence of financing, infrastructure, workforce, service delivery, and information management on surgical care, and the current resolutions, such as humanitarian aid missions.

Surgical resources in South Africa: an analysis of the inequalities between the public and private sector

The full extent of the global burden of surgical disease is largely unknown, however, the scope of the problem is thought to be large. Despite the substantial burden of surgical disease, surgical services are inaccessible to many of those who need them most. There are disparities between public and private sectors in South Africa, which compound inequitable access to surgical care. This study forms part of a series analysing surgical resources in South Africa. This study involved a descriptive analysis of surgical resources and included the total number of hospitals, of hospital beds, the number of surgical beds, the number of general surgeons (specialist and non-specialist), and the number of functional operating theatres in South Africa. A comparison was performed between the public and private sectors. Hospitals were contacted during the period from 1 October 2014 until 31 December 2014. Surgical resources were concentrated in metropolitan areas of urban provinces. There were striking differences between the public and private sectors, where private resources were comparable to those available in high income countries (HICs). Improving access to surgical services in lower middle income countries (LMICs) requires addressing gaps between the public and private sector regarding infrastructure, personnel, as well as equipment. These data identified disparities between geographic regions which may be contributing to ongoing inequity in South Africa, and by doing so allows for evidence-based planning towards improving surgical infrastructure and workforce.

Geographical maldistribution of surgical resources in South Africa: A review of the number of hospitals, hospital beds and surgical beds.

The global burden of surgical disease has been studied to a limited extent. Despite the proven benefits of surgery, surgical services remain poorly resourced. Contributing to this global crisis is the critical lack of data regarding available resources. To analyse the distribution of some resources necessary for the provision of surgical care. The distribution and number of surgical resources (number of surgical beds) relative to the general resources (number of hospitals and total number of beds) in South Africa were analysed. All hospitals in the country, including those in the public and private sectors, were contacted, and the total number of hospitals, the level of care (district v. regional v. tertiary), the total number of hospital beds, and the number of surgical beds were determined. The data were analysed according to the provincial distribution and the public v. private sector distribution relative to the size of the population. A total of 544 hospitals were included in the study - 327 in the public sector and 217 in the private sector. The public sector hospitals included 257 district-, 49 regional- and 21 tertiary-level hospitals. Nationally, there were 1 hospital, 187 hospital beds and 42 surgical beds per 100 000 population. Gauteng Province (GP), the Eastern Cape, KwaZulu-Natal (KZN) and the Western Cape had the most hospitals and GP had the largest number of private hospitals. GP and KZN had the largest total number of beds (n=29 181 and n=22 889, respectively) and number of surgical beds (n=7 289 and n=4 651, respectively). GP had the largest number of private surgical beds (n=4 837). There was a marked variation in the number of hospitals, total number of beds, and number of surgical beds among provinces. This study provided an estimation of the number of hospitals, total number of beds, and number of surgical beds, and showed a marked variation among provinces and between the public and private sectors.