Global Surgery and Poverty

Excerpt

Surgically treated disorders represent a significant proportion of the burden of the diseases associated with poverty. Furthermore, surgery is a cost-effective method of reducing suffering, prolonging life, and restoring sick and injured people to health and economic productivity.

Some 2 billion people worldwide lack access to surgical care (Funk and others 2010). The maldistribution of surgical resources between high-income countries (HICs) and low- and middle-income countries (LMICs) is striking. HICs have an average of 14 operating rooms and 45 trained surgeons per 100,000 population; LMICs have fewer than 2 operating rooms and 1 trained surgeon per 100,000 population (MacGowan 1987). Only 3.5 percent of the estimated 234 million operations performed annually occur in the poorest countries that spend less than US$100 per capita annually on health care, although these countries account for 34.8 percent of the global population (Weiser and others 2008).

The barriers to surgical access, including lack of awareness, fear, distance, and cultural beliefs, are many. However, the principal barrier appears to be the cost of care (Malhotra and others 2005). For example, 91 percent of the respondents to a survey of cataract patients in Ghana cited cost as a significant barrier to treatment (Gyasi, Amoaku, and Asamany 2007). Similar barriers have been cited for hospital delivery and access to obstetric services in rural Kenya (Myangome and others 2012).

Many hospitals serving poor people charge a fee for care. Sometimes the charge is based on the belief that uncompensated services are not valued by those who receive them, although no literature confirms or refutes this hypothesis. More often, the costs of admission, medications, and food are based on the harsh economic realities of impoverished countries. However, even a nominal fee may serve as a major barrier to destitute patients who need care.