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Barriers to the Delivery of Orthopedic Care

  • David A. SpiegelEmail author
  • Stephen W. Bickler
Chapter

Abstract

Inadequate access to surgical care results in considerable morbidity and mortality, especially for marginalized segments in low- and middle-income countries (LMICs). Surgery has traditionally been neglected as a public health strategy due to the perception that it is costly and resource-intensive and benefits few within a population, but has received greater attention as a public health intervention in LMICs over the past few years, leading to a number of publications and a resolution at the 68th World Health Assembly titled “Strengthening Emergency and Essential Surgical Care and Anaesthesia as a Component of Universal Health Coverage” (2015) [6]. There are numerous barriers to the delivery of surgical services in LMICs, most falling within the general domains of social/cultural, financial, and structural. Services must be physically accessible, available, afforbable, and acceptable.

References

  1. 1.
    Meara JG, Leather AJ, Hagander L, et al. Global surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386:569–624.CrossRefGoogle Scholar
  2. 2.
    Debas HT, Donkor P, Gawande A, Jamison DT, Kruk ME, Mock CN, editors. Essential surgery: disease control priorities, vol. 1. 3rd ed. Washington, D.C.: The International Bank for Reconstruction and Development/The World Bank; 2015.(Open Access).Google Scholar
  3. 3.
    Spiegel DA, Gosselin RA. Surgical services in low-income and middle-income countries. Lancet. 2007;370:1013–5.CrossRefGoogle Scholar
  4. 4.
    Shrime MG, Bickler SW, Alkire BC, Mock C. Global burden of surgical disease: an estimation from the provider perspective. Lancet Glob Health. 2015;3(Suppl 2):S8–9. (Open Access).CrossRefGoogle Scholar
  5. 5.
    World Health Organization (2005) Global initiative for emergency and essential surgical care. Available at: http://www.who.int/surgery/globalinititiative/en/. Accessed 12 Apr 2018.
  6. 6.
    Strengthening emergency and essential surgical care and anaesthesia as a component of universal health coverage. Available at http://apps.who.int/gb/ebwha/pdf_files/WHA68/A68_R15-en.pdf. Accessed 4/10/18.
  7. 7.
    Rose J, Weiser TG, Hider P, Wilson L, Gruen RL, Bickler SW. Estimated need for surgery worldwide based on prevalence of diseases: a modelling strategy for the WHO Global Health Estimate. Lancet Glob Health. 2015;3(Suppl 2):S13–20. (Open Access).CrossRefGoogle Scholar
  8. 8.
    Grimes CE, Bowman KG, Dodgion CM, et al. Systematic review of barriers to surgical care in low-income and middle-income countries. World J Surg. 2011;35:941–50.CrossRefGoogle Scholar
  9. 9.
    Spiegel DA, Misra M, Bendix P, et al. Surgical care and health systems. World J Surg. 2015;39:2132–9.CrossRefGoogle Scholar
  10. 10.
    Spiegel DA, Droti B, Relan P, et al. Retrospective review of surgical availability and readiness in 8 African countries. BMJ Open. 2017;7:e014496. (Open Access).CrossRefGoogle Scholar
  11. 11.
    Kushner AL, Cherian MN, Noel LPJ, Spiegel DA, Groth S. Addressing the millennium development goals from a surgical perspective: deficiencies in the capacity to deliver safe surgery and anesthesia in 8 low and middle-income countries. Arch Surg. 2010;145:154–60.CrossRefGoogle Scholar
  12. 12.
    Spiegel DA, Nduaguba A, Cherian MN, et al. Deficiencies in the availability of essential musculoskeletal surgical services at 883 health facilities in 24 low- and lower-middle-income countries. World J Surg. 2015;39:1421–14.CrossRefGoogle Scholar
  13. 13.
    Mock CN, Cherian MN, Juillard C, Donkor P, Bickler S, Jamison D, McQueen K. Developing priorities for addressing surgical conditions globally: furthering the link between surgery and public health policy. World J Surg. 2010;34:381–5.CrossRefGoogle Scholar
  14. 14.
    Spiegel DA, Abdullah F, Price RR, Gosselin RA, Bickler SW. World Health Organization Global Initiative for Emergency and Essential Surgical Care: 2011 and beyond. World J Surg. 2013;37:1462–9. (Open Access).CrossRefGoogle Scholar
  15. 15.
    Shawar YR, Shiffman J, Spiegel DA. Generation of political priority for global surgery: a qualitative policy analysis. Lancet Glob Health. 2015;3:e487–95. (Open Access).CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Division of Orthopedic Surgery, Children’s Hospital of PhiladelphiaUniversity of Pennsylvania School of MedicinePhiladelphiaUSA
  2. 2.Hospital and Rehabilitation Centre for Disabled Children (HRDC)BanepaNepal
  3. 3.Department of Pediatric Surgery, Rady Children’s HospitalUniversity of California San DiegoSan DiegoUSA

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