Global Health Policy Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, United Kingdom.
Nuffield Centre for International Health and Development, University of Leeds, Leeds, West Yorkshire, United Kingdom.
PLoS One. 2024 Jun 26;19(6):e0287941. doi: 10.1371/journal.pone.0287941. eCollection 2024.
Surgical services are scarce with persisting inequalities in access across populations and regions globally. As the world's most populous county, India's surgical need is high and delivery rates estimated to be sub-par to meet need. There is a dearth of evidence, particularly sub-regional data, on surgical provisioning which is needed to aid planning.
This mixed-methods study examines the state of surgical care in Northeast India, specifically health care system capacity and barriers to surgical delivery. It involved a facility-based census and semi-structured interviews with surgeons and patients across four states in the region.
Abdominal conditions constituted a large portion of the overall surgeries across public and private facilities in the region. Workloads varied among surgical providers across facilities. Task-shifting occurred, involving non-specialist nursing staff assisting doctors with surgical procedures or surgeons taking on anaesthetic tasks. Structural factors dis-incentivised facility-level investment in suitable infrastructure. Facility functionality was on average higher in private providers compared to public providers and private facilities offer a wider range of surgical procedures. Facilities in general had adequate laboratory testing capability, infrastructure and equipment. Public facilities often do not have surgeon available around the clock while both public and private facilities frequently lack adequate blood banking. Patients' care pathways were shaped by facility-level shortages as well as personal preferences influenced by cost and distance to facilities.
Skewed workloads across facilities and regions indicate uneven surgical delivery, with potentially variable care quality and provider efficiency. The need for a more system-wide and inter-linked approach to referral coordination and human resource management is evident in the results. Existing task-shifting practices, along with incapacities induced by structural factors, signal the directions for possible policy action.
全球各地的医疗服务都很匮乏，在人口和地区之间存在着持续的不平等。印度是世界上人口最多的国家，其手术需求很高，但手术提供率估计不足以满足需求。缺乏证据，特别是关于手术供应的次区域数据，这对于规划是必要的。
这项混合方法研究考察了印度东北部的外科护理状况，特别是医疗保健系统的能力和外科手术提供的障碍。它涉及对该地区四个邦的医疗机构进行了普查，并对医生和患者进行了半结构化访谈。
腹部疾病构成了该地区公共和私人医疗机构整体手术的主要部分。手术提供者之间的工作量在不同机构之间存在差异。任务转移发生了，涉及非专业护理人员协助医生进行手术程序或外科医生承担麻醉任务。结构性因素不利于医疗机构在合适的基础设施上进行投资。与公共医疗机构相比，私立医疗机构的设施功能平均更高，并且提供更广泛的手术程序。一般来说，医疗机构都有足够的实验室检测能力、基础设施和设备。公共设施通常没有医生 24 小时值班，而公共和私人设施通常都缺乏足够的血库。患者的护理路径受到设施层面短缺以及个人偏好的影响，这些偏好受到成本和到设施的距离的影响。
各机构和地区之间的工作量不平衡表明手术提供不均衡，可能存在不同的护理质量和提供者效率。结果表明，需要更系统和相互关联的方法来协调转诊和人力资源管理。现有的任务转移实践，以及结构因素造成的能力不足，表明了可能的政策行动方向。
