Bridging the Gap in Surgical Care: A Neglected Public Health Issue in India

Access to surgical care is a fundamental right, but for millions of individuals in India, this right remains elusive, transforming surgery into an unaffordable luxury. Sadly, this situation is not unique to India; it reflects the broader challenges faced by low- and middle-income countries in providing adequate surgical care.

The Unseen Crisis

Access to surgical care is a critical component of public health, but its significance often goes unnoticed. In many rural and remote parts of India, people struggle to reach healthcare facilities due to a lack of infrastructure, including inadequate road networks and ambulances. Even if they manage to arrive at a healthcare facility, they may find a shortage of essential resources, including trained surgeons, anesthetists, and clinical staff.

The Lancet Commission on Global Surgery (LCoGS)

To address these issues, the Lancet Commission on Global Surgery (LCoGS) has proposed a set of indicators to measure access to surgical care, including geographical access, workforce density, surgical volumes, perioperative mortality rate, and the risk of impoverishment due to surgery-related expenses. These indicators provide a comprehensive view of surgical care at both the population level and on the ground.

India’s Unique Challenges

India’s surgical care landscape is characterized by disparities in access based on geographical location, affordability, and the availability of healthcare resources. In rural India, where more than 90% of the population resides, access to surgery is severely limited. The scarcity of surgeons and anesthetists in these areas compounds the problem.

The Role of Quality Surgical Care

Access to surgery alone is not enough; the quality of surgical care is equally vital. Factors such as the training of surgeons, the availability of equipment, and appropriate perioperative care influence patient outcomes. The mortality rate following surgery serves as a sensitive indicator of safety, but data on perioperative mortality are often missing or inconsistent.

Financial Implications

In a country where universal healthcare coverage is absent, seeking care in private hospitals can lead to devastating financial consequences. More than 60% of surgery patients in rural India face catastrophic expenses, risking impoverishment.

Bridging the Gap

India’s current surgical care system relies on civilian initiatives and subnational programs to address systemic gaps. These initiatives, led by surgeons and organizations, play a crucial role in improving access to surgical care, particularly in underserved regions.

The Path Forward

To address these challenges and improve surgical care in India, recognizing the problem’s gravity is the first step. Surgical care access, the burden of preventable diseases related to surgery, and the economic impact of surgery should be integrated into mainstream public health discourse and policymaking.

Additionally, India needs to develop a National Surgical Obstetric Anaesthesia Plan (NSOAP) or a similar policy, as seen in many other countries in Africa and South Asia. Investment in data collection and monitoring systems for surgical care indicators is also essential to bridge the gap.

In conclusion, access to surgical care is a vital public health issue in India, with implications for millions of lives. It is crucial to recognize, address, and invest in surgical care to ensure that every individual, regardless of their condition, can exercise their fundamental right to access surgery when needed.

Source: The Hindu