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Mahesh

09/01/24 07:26 AM IST

Surgical care in India is a neglected part of public health

In News
  • Millions of children and adults around India, regardless of the severity of their condition, injury, need or affordability, are forced to treat the basic right of surgery as a luxury.
The Lancet Commission on Global Surgery (LCoGS)
  • In 2015, LCoGS researchers found that New Zealand, which has universal health coverage, had 5,000 surgeries per 100,000 people.
  • With a population of about 1.4 billion, the rate of surgeries in India is somewhere between 166 and 3,646 surgeries per 100,000, depending on the setting, population, and other factors.
Right to access surgery
  • In fact, five billion people around the world are deprived of the fundamental right to access surgery when required.
  • More than 90% of rural Indians are estimated to not have access to surgery when required. India’s limited data on LCoGS indicators reveals several reasons for this.
  • First, many people are unable to reach the hospital on time.
  • A lack of facilities, poor road network, lack of vehicles (including ambulances), etc. contribute to the lack of timely access. Such access problems are more common in rural, remote, and hilly areas that together house more than two-thirds of the population.
  • Second, even if someone is able to reach a facility, there might not be the necessary resources for treatment.
  • Third, the capacity to perform enough surgeries is also undermined by disparities based on where one lives, how much one is able to pay, etc. The met need for major surgeries is less than 7% in rural India.
  • Fourth, the quality of surgical care determines whether someone will have safe outcomes. This depends on surgeons’ training, the availability of necessary equipment, and the presence of appropriate peri-operative care, among other factors.
  • Fifth, due to the absence of universal healthcare coverage and limited surgical-care capability among public health facilities that provide free or subsidised care, the financial impact on people forced to seek care in private hospitals can be devastating. More than 60% of surgery patients in rural India face catastrophic expenses and several thousand risk impoverishment.
Gaps in surgical care
  • India’s current surgical system gets by on civilian initiatives and subnational programmes – including countless surgeon-led small private establishments and government teaching and public district hospitals – that plug systemic gaps in surgical care.
  • Noteworthy examples include rural surgeons gathered under the Association for Rural Surgeons of India; emergency and trauma care, including free ambulance services in multiple states, by the EMRI Green Health Services; and organisations such as the Society for Education.
Action plan
  • The main issue is a lack of problem recognition.
  • Lack of surgical care access, preventable disease burden due to surgery, and the economic toll of surgery on society are still not considered to be a part of public health in the mainstream.
  • Over the last seven decades, India’s focus on surgical care has been limited, with little attention in the most recent National Health Policy (2017).
  • Since the publication of LCoGS, many countries in Africa and South Asia have initiated National Surgical Obstetric Anaesthesia Plans (NSOAPs) or equivalent policies. India currently has no NSOAP.
  • The lack of investments in data for monitoring and evaluation of surgical care indicators has also been a major roadblock.
  • So, using existing data, integrating surgical care data in existing surveys and systems, and building new dedicated data collection mechanisms are the ways out.
Source- The Hindu

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