This blog is part of a series of blogs written by participants at HSR 2022 reflecting on some of the key messages and learnings emerging from the symposium.
I want to share some thoughts and reflections that my best friend, who is a surgeon in Guatemala, and I have had on many occasions feeling frustrated about the Guatemalan health system and after attending the amazing conference at HSR 2022 “Addressing the challenges of delivering effective surgery care through health policy and system research” we might be able plant an idea that could become the beginning of a solution.
My friend has shared constantly her frustration regarding having to postpone or cancel elective surgeries that have been programmed over months. I have experienced very closely having to wait for three months on a surgery of a loved one, just to have it cancelled a week before without any explanation is horrible. Not to mention that most of the surgeries are just performed in some towns and others just in the City, so having a surgery can represent traveling from remote areas for many hours (Dr. Maria Aguilera mention that in Guatemala a patient can travel up to 7 hours to get a specific surgery that is only performed in the City). Imagine the expenses, specially in a country where minimum wage is about USD $357 per month and 50% of the population live below poverty line. Sadly, this is a reality in many low-income countries. The impact of early surgery reduces future morbidity and mortality, and this should not be a privilege of high-income countries or for people who can afford it as a luxury.
Dr. James Glasbey’s was presenting his research paper “Elective surgery system strengthening development, measurement, and validation of the surgical preparedness index across 1632 hospitals in 119 countries” and he had had not even finished when I texted my friend and told her “look at this, I think this is how change can start”.
A little bit of context of our discussion is that before covid the Guatemalan health system was not able to serve the population due to deficiency in infrastructure, personal and beds, so during COVID-19 the system had an external stress. This makes sense, because for more than a decade the total health expenditure as a percentage of the GDP has been 5.7% one of the lowest in the region. The reality is that 2.05% total health expenditure comes from the Public Sector which means that 60% of the total health expenditure comes from the private sector mainly as out-of-pocket representing 3.65% of GDP.
Where to start then? The WHO defines health equity as “the absence of unfair, avoidable or remediable differences in health among population groups, defined by social, economic, demographic or geographic characteristics”. Dr Glasbey and colleagues propose a surgical preparedness index than includes twenty-three variables on the check list divided into four main categories: Facilities and consumables; Staffing; Prioritization; System. So here is where one can start.
There are some many things that can be done to try to achieve health equity. Although we discussed Guatemala, the problem of postponing and cancelling surgeries is an increasing problem worldwide and it might be a realty of many other low and middle-income countries. I think the scarce resources can be prioritize following the results from the surgical preparedness index so an essential treatment like any other could be accessible for a wider population.
By Mercedes Molina, Universidad Rafael Landivar