Access to Essential Surgical Care in Chiapas, Mexico: A System-Wide Geospatial Analysis

World Journal of Surgery (2021)Cite this article

Abstract

Background

Long travel times to reach essential surgical care in Chiapas, Mexico’s poorest state, can delay lifesaving procedures and contribute to adverse outcomes. Geographical access to surgical facilities is 1 of the 6 indicators of the Lancet Commission on Global Surgery and has been measured extensively worldwide. Our objective is to determine the population with 2-h geographical access to facilities capable of performing the Bellwether procedures (laparotomy, cesarean delivery, and open fracture repair). This is the first study in Mexico to assess access to surgical facilities, including both the fragmented public sector and the private sector.

Methods

In this cross-sectional study, conducted from June 2019 to January 2020, Bellwether capable surgical facilities from all health systems in Chiapas were geocoded and assessed through on-site data collection, Ministry of Health databases, and verified via telephone. Geospatial analyses were performed on Redivis.

Results

We identified 59 Bellwether capable hospitals, with 17.5% (n = 954,460) of the state residing more than 2 h from surgical care in public and private health systems. Of those, 22 facilities had confirmed 24/7 Bellwether capability, and 23% (n = 1,178,383) of the affiliated population resided more than 2 h from these hospitals.

Conclusions

Our study shows that the Ministry of Health and employment-based health coverage could provide timely access to essential surgical care for the majority of the population. However, the fragmentation of the healthcare system leaves a gap that contributes to delays in care and unmet emergency surgical needs.

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Funding

PGSSC receives grant support from GE Foundation for the SS2020 Program.

Author information

Affiliations

  1. Compañeros en Salud, Jaltenango, CHIS, México

    Fernando Carrillo-Villaseñor, Valeria Macias & Sebastián Mohar

  2. Ciencias de la Salud y Escuela de Medicina, Tecnológico de Monterrey, 2514 Av. Gral Ramón Corona, 45201, Guadalajara, JAL, México

    Fernando Carrillo-Villaseñor

  3. Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA

    Zachary Fowler, Ellie Moeller, Lina Roa, Rachel Koch, Luke Caddell, Robert Riviello, John G. Meara & Tarsicio Uribe-Leitz

  4. Institute for Advanced Study of the Americas, University of Miami, Miami, FL, USA

    Ellie Moeller

  5. Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Canada

    Lina Roa

  6. Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

    Rachel Koch

  7. Hospital Básico Comunitario Ángel Albino Corzo, Secretaría de Salud, Jaltenango, CHIS, México

    Sebastián Mohar & Sabrina Cervantes

  8. Redivis Inc, Mountain View, CA, USA

    Ian Mathews

  9. Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, USA

    Robert Riviello & Tarsicio Uribe-Leitz

  10. Anahuac Institute of Public Health and Carlos Peralta Chair of Public Health, Faculty of Health Sciences, Universidad Anáhuac, Huixquilucan, MEX, México

    Arturo Cervantes-Trejo

  11. Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, MA, USA

    John G. Meara

  12. Department of Sport and Health Sciences, Technical University Munich,Epidemiology, Munchen, Germany

    Tarsicio Uribe-Leitz

Authors
  1. Fernando Carrillo-Villaseñor
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  2. Zachary Fowler
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  3. Ellie Moeller
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  4. Lina Roa
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  5. Valeria Macias
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  6. Rachel Koch
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  7. Sebastián Mohar
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  8. Luke Caddell
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  9. Sabrina Cervantes
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  10. Ian Mathews
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  11. Robert Riviello
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  12. Arturo Cervantes-Trejo
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  13. John G. Meara
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  14. Tarsicio Uribe-Leitz
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Corresponding author

Correspondence to Fernando Carrillo-Villaseñor.

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Carrillo-Villaseñor, F., Fowler, Z., Moeller, E. et al. Access to Essential Surgical Care in Chiapas, Mexico: A System-Wide Geospatial Analysis. World J Surg (2021). https://doi.org/10.1007/s00268-021-05975-y

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