M. P. Vega1,5, A. N. Bowder1,2,5, N. P. Raykar1,3,5, F. Oher1, J. G. Meara1,5, E. Makasa6 1Program In Global Surgery And Social Change, Harvard Medical School,Department Of Global Health And Social Medicine,Boston, MA, USA 2University Of Nebraska Medical School,Omaha, NB, USA 3Beth Israel Deaconess Medical Center,Department Of Surgery,Boston, MA, USA 5Boston Children’s Hospital,Department Of Oral And Plastic Surgery,Boston, MA, USA 6Permanent Mission Of The Republic Of Zambia To The United Nations In Geneva & The Ministry Of Health,Lusaka, , Zambia
Introduction: One of the The Lancet Commission on Global Surgery’s six indicators for global surgery systems strengthening is the percent of a country’s population within two hours of a facility that can provide the Bellwether procedures (1). Previous work by the Commission focused on estimating access to surgical care through geospatial mapping of surgical providers in nine countries (2). Given the general availability of information on hospital locations, we wished to use surgical facility location to determine the upper bound of a country’s population with access to surgical care within two hours, and compare differences between a high-resource country (Sweden) and a low-resource one (Zambia).
Methods: We gathered surgical facility data from Zambia’s Ministry of Health List of Health Facilities in Zambia (3). We included 1st, 2nd and 3rd level hospitals offering of surgical services in our analysis. Surgical facilities in Sweden were identified from the Swedish National Board of Health and Welfare and publicly available online resources (4). Google Maps Engine was used to locate the identified surgical facilities and to create two-hour driving zones around each location. Finally, the Socioeconomic Data and Applications Center Population Estimation Service was used to estimate the population living within each access zone (5).
Results: We identified 77 hospitals in Sweden and 100 hospitals in Zambia, which provided general surgery care. An estimated 99.52% of the Swedish population lives within two hours driving distance to a surgical facility, as compared to 74.28% of the Zambian population. Geographic size of these nations and road conditions and driving times influence these numbers.
Conclusion: Sweden and Zambia have disparate but high proportions of their population that live within two hours, driving distance, of a surgical facility. However, ease of transportation to these facilities, workforce availability and functionality, and affordability of surgical services will determine true access to surgical care. Nonetheless, knowledge of the distribution of surgical facilities in relation to population distribution is critical information for health systems planning. Geospatial mapping of surgical facilities should be used in conjunction with contextual differences in geography, seasonal variation in road quality, population access to vehicular transportation, and distribution of vulnerable populations to direct investments into new surgical facilities or to optimize existing ones.
