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Assessment of Essential Surgical and Anaesthesia Care Capacity: A Cross-Sectional Study in Five Pacific Island Countries
21 Pages Posted: 7 Feb 2023
More...Abstract
Background: Pacific Island Countries (PICs) face unique challenges in providing surgical care. We assessed the surgical care capacity of five PICs to inform the development of National Surgical, Obstetric and Anaesthesia Plans (NSOAP).
Methods: We conducted a cross-sectional survey of 26 facilities in Fiji, Tonga, Vanuatu, Cook Islands, and Palau using the World Health Organization - Program in Global Surgery and Social Change Surgical Assessment Tool.
Findings: Eight referral and 18 first-level hospitals containing 39 functioning operating theatres, 41 post-anaesthesia care beds, and 44 intensive care unit beds served a population of 1,321,000 across the five countries. Most facilities had uninterrupted access to electricity, water, internet, and oxygen. However, CT was only available in 2/8 referral hospitals, MRI in 1/8, and timely blood transfusions in 4/8. The surgical, obstetric, and anaesthetist specialist density per 100,000 people was the highest in Palau (49·7), followed by Cook Islands (22·9), Tonga (11·5), Fiji (7·1), and Vanuatu (5·0). There were four radiologists and 3·5 pathologists across the five countries. Surgical volume per 100,000 people was the lowest in Vanuatu (860), followed by Fiji (2,247), Tonga (2,864), Cook Islands (6,747), and Palau (8,606). The peri-operative mortality rate was prospectively monitored in Tonga and Cook Islands and was below 1% in all five countries.
Interpretation: Whilst PICs share common challenges in providing specialised tertiary services, there is substantial diversity between the countries. Strategies to strengthen surgical systems should incorporate both local contextualisation within each PIC and regional collaboration between PICs.
Funding: None.
Declaration of Interests: The authors declare no competing interest.
Ethics Approval: Ethics approval was granted by the Harvard Longwood Campus Institutional Review Board and the Ministry of Health ethics committee in each study country.
Keywords: global surgery, Pacific Island Countries, health system strengthening, national surgical planning
Suggested Citation: Suggested Citation