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

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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References

  1. 1.

    Meara JG, Leather AJM, Hagander L et al (2015) Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet (Lond Engl) 386:569–624

    Article  Google Scholar 

  2. 2.

    Jamison DT, Gelband H, Horton S et al, Essential Surgery (2015) Debas HT, Donkor P, Gawande A, Disease Control Priorities, The International Bank for Reconstruction and Development. The World Bank: Washington D.C, (Volume 1) Third Edition

  3. 3.

    Alcocer JC, Robledo Z, Ramírez LA, et al. (2019) Atención Primaria de Salud Integral e Integrada APS-I MX: La Propuesta Metodológica y Operativa. Secretaría de Salud, Ciudad de México, p 26–141

  4. 4.

    Encuesta Intercensal (2015) Principales resultados de la Encuesta Intercensal 2015. Estados Unidos Mexicanos/Instituto Nacional de Estadística y Geografía, México, p 16–62

  5. 5.

    Presentación Ejecutiva estatal Chiapas (2018) Encuesta Nacional de Ingresos y Gastos de los Hogares (ENIGH) 2018 Chiapas. Instituto Nacional de Estadística y Geografía, México

  6. 6.

    Informe Chiapas (2020) Informe de Pobreza y Evaluación 2020. Consejo Nacional de Evaluación de la Política de Desarrollo Social (CONEVAL), Ciudad de México, p 14–39

  7. 7.

    Frenk J, González-Pier E, Gómez-Dantés O et al (2006) Comprehensive reform to improve health system performance in Mexico. Lancet (Lond Engl) 368:1524–1534

    Article  Google Scholar 

  8. 8.

    Frenk J, Gómez-Dantés O, Knaul FM et al (2009) The democratization of health in Mexico: financial innovations for universal coverage. Bull World Health Organ 87:542–548

    Article  Google Scholar 

  9. 9.

    Informe al Ejecutivo Federal y al Congreso de la Unión Sobre la Situación Financiera y los Riesgos del Instituto Mexicano del Seguro Social 2018–2019, 2009 Instituto Mexicano del Seguro Social Ciudad de Mexico 1 213 235

  10. 10.

    Knaul FM, González-Pier E, Gómez-Dantés O et al (2012) The quest for universal health coverage: achieving social protection for all in Mexico. Lancet (Lond Engl) 380:1259–1279

    Article  Google Scholar 

  11. 11.

    Estudio Diagnóstico del Derecho a la Salud (2018) Consejo Nacional de Evaluación de la Política de Desarrollo Social (CONEVAL), Ciudad de México, p 20–66

  12. 12.

    Reglas de Operación del Programa Seguro Médico Siglo XXI, para el Ejercicio Fiscal 2020 (2019) Diario Oficial de la Federación, Ciudad de México

  13. 13.

    Planeación a la Salud (2019) Sistema Nacional de Salud e Instituto de Salud para el Bienestar (INSABI), Secretaría de Salud

  14. 14.

    Alcocer JC, Christina AS, López-Gatell H (2020) Intervenciones de APS-I Mx en los Distritos de Salud. Secretaría de Salud, Ciudad de México

  15. 15.

    Programa Sectorial Derivado del Plan Nacional de Desarrollo 2019–2020 (2020) Diario Oficial de la Federación, Ciudad de México

  16. 16.

    Directorio Estadístico Nacional de Unidades Económicas (2019) Instituto Nacional de Estadística y Geografía (INEGI). https://www.inegi.org.mx/app/mapa/denue/default.aspx

  17. 17.

    Dirección General de Información en Salud (2009) Clasificación de Procedimientos (Volumen 3 de la CIE-9-MC), Secretaria de Salud, Ciudad de Mexico

  18. 18.

    Cubos dinámicos (2019) Dirección General de Información en Salud. http://www.dgis.salud.gob.mx/contenidos/basesdedatos/Datos_Abiertos_gobmx.html

  19. 19.

    Lin Y, Raykar NP, Saluja S et al (2020) Identifying essential components of surgical care delivery through quality improvement: An updated surgical assessment tool. Int J Surg (Lond Engl) 82:103–107

    Article  Google Scholar 

  20. 20.

    Principales resultados del Censo de Población y Vivienda 2010 Chiapas (2011) Censo de Población y Vivienda.  Instituto Nacional de Estadística y Geografía (INEGI), México

  21. 21.

    Esquivel MM, Uribe-Leitz T, Makasa E et al (2016) Mapping Disparities in Access to Safe, Timely, and Essential Surgical Care in Zambia. JAMA Surg 151:1064–1069

    Article  Google Scholar 

  22. 22.

    Roa L, Uribe-Leitz T, Fallah PN et al (2020) Travel Time to Access Obstetric and Neonatal Care in the United States. Obstet Gynecol 136:610–612

    Article  Google Scholar 

  23. 23.

    Rudolfson N, Gruendl M, Nkurunziza T, Kateera F, Sonderman K, Nihiwacu E et al (2020) Validating the global surgery geographical accessibility indicator: differences in modeled versus patient-reported travel times. World J Surg 44(7):2123–2130. https://doi.org/10.1007/s00268-020-05480-8

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Comber AJ, Brunsdon C, Radburn R et al (2011) A spatial analysis of variations in health access: linking geography, socio-economic status and access perceptions. Int J Health Geogr 10:44

    Article  Google Scholar 

  25. 25.

    Reviews OECD, of Health Systems: Mexico, (2016) (2020) OECD Reviews of Health Systems. OECD Publishing, Paris

    Google Scholar 

  26. 26.

    Instituto de Salud para el Bienestar (2020) El Pulso de la Salud 04 de febrero de 2020. Secretaría de Salud, México

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Funding

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

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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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