N. P. Raykar1,2,3, A. N. Bowder3,4, M. P. Vega3, J. Kim3,5, G. N. Boye2, S. L. Greenberg2,3,6, J. N. Riesel2,3,7, R. D. Gillies3, J. G. Meara2,3, N. Roy8 1Beth Israel Deaconess Medical Center,Boston, MA, USA 2Children’s Hospital Boston,Boston, MA, USA 3Harvard School Of Medicine,Program In Global Surgery And Social Change,Brookline, MA, USA 4University Of Nebraska College Of Medicine,Omaha, NE, USA 5Tufts Medical Center,Boston, MA, USA 6Medical College Of Wisconsin,Milwaukee, WI, USA 7Massachusetts General Hospital,Boston, MA, USA 8BARC Hospital,Mumbai, MH, India
Introduction: The Lancet Commission on Global Surgery calls for universal access to safe, affordable and timely surgical care. Unfortunately, billions of people currently lack access to such care due to myriad factors including severe deficits in the surgical workforce. Little is known, though, about the distribution of surgeons and their accessibility to patients in low-resource settings — this makes allocation of human and physical resources challenging. Geospatial mapping can be used to (1) identify populations that lack timely access to surgical care (defined as living within two hours of a surgical provider) and (2) understand variations in surgeon-to-population density that can impact service availability.
Methods: The number and practice location of surgeons was obtained from Ministries of Health, professional societies, registration databases, personnel with in-country knowledge of surgeon distribution, and the published literature. Spatial distribution of providers was mapped using online mapping software. Two-hour driving zones were constructed around each provider location through analysis of roads and driving times calculated from Google Maps. The number of people living within these zones was estimated using the Socioeconomic Data and Applications Center Population Estimation Service.
Results:Analysis was completed on data from nine countries: Mongolia, Namibia, Papa New Guinea, Sierra Leone, Somaliland, Zimbabwe, nine states in Nigeria, six states in India, and one state in Ecuador. Percentages of populations living within two hours of a surgical provider vary dramatically, ranging from 4.7% (Chhattisgarh state, India) to 88.6% (Ogun state, Nigeria). Surgeon-to-population ratios ranged from 1:10,500 (Mongolia) to 1:1,360,000 (rural Kerala state, India). Surgeon-to-population ratios also vary dramatically within the same country. In Sierra Leone, for example, the urban surgeon-to-population ratio was 1:80,900 compared to the rural surgeon-to-population ratio of 1:383,000.
Conclusion:Access to surgical care in the resource-limited setting is contingent upon multiple factors. The most fundamental of these is availability of and access to a surgeon. Geospatial mapping of surgical providers shows that regardless of national surgical numbers, many populations in the world still lack access to timely surgical care. Wide variability in timely and available access exists between and within countries. Geospatial mapping has the unique ability to illustrate coverage gaps in a meaningful way. Understanding these access patterns can prove useful in addressing national deficits in surgical care.
