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Global surgery system strengthening: it is all about the right metrics
journal contribution
posted on 2018-04-01, 00:00 authored by David WattersDavid Watters, Glenn GuestGlenn Guest, Viliami Tangi, Mark G Shrime, John G MearaProgress in achieving "universal access to safe, affordable surgery, and anesthesia care when needed" is dependent on consensus not only about the key messages but also on what metrics should be used to set goals and measure progress. The Lancet Commission on Global Surgery not only achieved consensus on key messages but also recommended 6 key metrics to inform national surgical plans and monitor scale-up toward 2030. These metrics measure access to surgery, as well as its timeliness, safety, and affordability: (1) Two-hour access to the 3 Bellwether procedures (cesarean delivery, emergency laparotomy, and management of an open fracture); (2) Surgeon, Anesthetist, and Obstetrician workforce >20/100,000; (3) Surgical volume of 5000 procedures/100,000; (4) Reporting of perioperative mortality rate; and (5 and 6) Risk rates of catastrophic expenditure and impoverishment when requiring surgery. This article discusses the definition, validity, feasibility, relevance, and progress with each of these metrics. The authors share their experience of introducing the metrics in the Pacific and sub-Saharan Africa. We identify appropriate messages for each potential stakeholder-the patients, practitioners, providers (health services and hospitals), public (community), politicians, policymakers, and payers. We discuss progress toward the metrics being included in core indicator lists by the World Health Organization and the World Bank and how they have been, or may be, used to inform National Surgical Plans in low- and middle-income countries to scale-up the delivery of safe, affordable, and timely surgical and anesthesia care to all who need it.
History
Journal
Anesthesia and analgesiaVolume
126Issue
4Pagination
1329 - 1339Publisher
Lippincott, Williams & WilkinsLocation
Philadelphia, Pa.Publisher DOI
ISSN
0003-2999eISSN
1526-7598Language
engPublication classification
C1 Refereed article in a scholarly journalCopyright notice
2018, International Anesthesia Research SocietyUsage metrics
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Lancet Commission on Global Surgerynational surgical planssurgeryBellwether proceduresSurgeonAnesthetistObstetricianAfricapatientpractitionersproviderspublicpoliticianspolicymakerspayersScience & TechnologyLife Sciences & BiomedicineAnesthesiologyPERIOPERATIVE MORTALITY-RATEMIDDLE-INCOME COUNTRIESSURGICAL MORTALITYEMERGENCY LAPAROTOMYHEALTHANESTHESIAWORKFORCECAREINITIATIVES
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