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Traumatic Disparities: Surgical Disease and the Great Divergence

Traumatic Disparities: Surgical Disease and the Great Divergence. June 2014. Universal access to safe, affordable surgical and anesthesia care when needed. Vision. UHC. Health Equity. LCoGS Mission. Raise global surgery within the international agenda

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Traumatic Disparities: Surgical Disease and the Great Divergence

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  1. Traumatic Disparities: Surgical Disease and the Great Divergence June 2014

  2. Universal access to safe, affordable surgical and anesthesia care when needed Vision • UHC • Health Equity

  3. LCoGS Mission • Raise global surgery within the international agenda • Prioritize surgery within national policy • Improve surgical care delivery (access/quality/safety) • All with a goal of achieving our vision

  4. Stakeholders/Audience:For whom are we responsible?

  5. Stakeholders/Audience:For whom are we responsible?

  6. Universal access to safe, affordable surgical and anesthesia care when needed Vision • UHC • Health Equity

  7. Stakeholders/Audience

  8. Stakeholders/Audience

  9. Stakeholders/Audience

  10. Recommendationsn = 37 Stakeholders:

  11. RecommendationsSample Suggestions • WHO/International Organizations • Include universal access to safe surgery in global health agenda • Collect and share data on metrics identified • Listen to, support LMICs based on local needs • Pressure gov’ts to improve surgery • Surgery as key component of UHC • Government/MOH/MOF • Include access to basic life-saving surgical care within national health plans. • Invest in human resources necessary for providing surgical/anesthesia services • Financial protection for poor patients undergoing surgery • Provide funding for surgical services • Foundations/Big Donors • Direct money into research, programmatic support and infrastructure • Fund programs that build capacity and focus on health system strengthening • Create a global surgical fund to support capability enhancement, system strengthening, and research • Colleges/Professional Societies • Locally based surgical education • Train surgeons in a way that meets population needs • Advise gov’ts on how to improve existing facilities • Support task sharing when requested by LMICs

  12. Traumatic Disparities: Surgical Disease and the Great Divergence June 2014

  13. Key Messages • Surgery is an indivisible, indispensible component of a properly functioning health system, UHC and SDGs, with the ultimate goal of health care equity • Trauma • Cancer • Investments in surgery are pro growth, cost effective and have a positive return on investment • How can we improve the situation? • How can it be paid for?

  14. Key Messagesn = 46

  15. Key Messages Other Messages: • Access to surgical care should be a universal human right. • Lack of surgical provision leads to an equity issue. • Appropriate training is essential to achieve global surgery. • Start with attention in trauma. When you have a good team to this attention, I think the surgical system works alone. • Safe and effective surgical care is the foundation of a functioning, strengthened health system.

  16. Traumatic Disparities: Surgical Disease and the Great Divergence June 2014

  17. Metricsn = 41

  18. Metrics Other Metrics: • ASA Class • Metric on blood and oxygen availability (units of blood collected? availability of blood and oxygen with urban/rural distribution?) • Is there any measurement of safe referral system? • Coverage (met need/unmet need)

  19. Requirements for Safe Surgeryn = 31

  20. Requirements for Safe Surgery Other Metrics: • Quality and delivery monitoring and feedback mechanism/audit process • Basic diagnostics • Aspirational: Pathology • Morbidity and mortality • Minimal lab tests and imagery • Diagnostics • Hygiene of the hospital setting • Ability to refer to a higher level of care via efficient transport system • Access to support and mentorship (e.g. more senior surgeon) • Performing surgery within established guidelines

  21. Future Research Agendan = 28 28 individual responses 82 research suggestions

  22. Future Research AgendaSample Suggestions • Implementation • Health system design and operational research • What are the optimal methods to deliver surgical care to a broad population quickly and effectively? Private practice model vs. public? • Research on how to improve systems for delivery of care and supply chain challenges • Quality • Identify quality issues that cut across all groups of surgery that can be used as a metric and for progress monitoring • Quality of surgical services: all three aspects of Donabedian Framework (structure, process, outcomes) • Financing • Financing: What proportion of GDP (both local and foreign) goes to surgical spending? • Capacity development: Impact of integrative capacity development on services • Workforce • Workforce training, distribution and retention • Benefits and disadvantages of task shifting • What are the key incentives to optimize retention and function of a workforce in a low-income environment?

  23. Traumatic Disparities: Surgical Disease and the Great Divergence June 2014

  24. Items requiring consensus

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