Pakistan's National Surgical, Obstetric, and Anesthesia Plan: an adapted model for a devolved federal-provincial health system
Pakistan's National Surgical, Obstetric, and Anesthesia Plan: an adapted model for a devolved federal-provincial health system
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DOI：
10.1007/s12630-020-01708-2
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发表时间：
2020-05-14
影响因子：
4.2
通讯作者：
Nishtar, Sania
中科院分区：
文献类型：
--
作者：
Fatima, Irum;Shoman, Haitham;Nishtar, Sania
近年来，获得安全的外科护理已被公认为一个主要的全球和公共卫生问题。2010年，1 690万人死于需要手术治疗的疾病;这超过了同期艾滋病毒/艾滋病、结核病和疟疾造成的死亡率之和。1据估计，通过获得基本外科护理，可避免7 700万残疾调整生命年。2在巴基斯坦，急性外科疾病造成每100 000人中有187人死亡，而传染病造成每100 000人中有164人死亡。2015年，《柳叶刀》全球外科委员会（LCoGS）发布了《2030年全球外科》报告，并提出了国家外科、产科和麻醉计划（NSOAP）方法，作为帮助承诺国家制定外科护理战略的指南。2在巴基斯坦，需要使用该框架的协调、全面和定制的方法来满足该国优化手术护理交付的需求。LCoGS框架建立在为NSOAP开发提供平台的六个相互依赖的领域之上：基础设施、劳动力、服务交付、融资、信息管理和治理。4 LCoGS还提出了六项指标来衡量基准和监测特定国家的外科护理进展。2其中包括：1）两小时内及时进行基本手术; 2）每100，000人的手术、麻醉和产科密度; 3）每100，000人的手术量; 4）围手术期死亡率; 5）支出贫困的风险;以及6）灾难性支出的风险。这些指标已列入世界银行集团的世界发展指标库，5从而使成员国有责任把重点放在外科护理上。
Access to safe surgical care has been acknowledged as a major global and public health concern in recent years. In 2010, 16.9 million people died from conditions requiring surgical care; this exceeded the mortality caused by HIV/AIDS, tuberculosis, and malaria combined during the same period. 1 It is estimated that 77 million disability-adjusted life years could be averted through access to basic surgical care. 2 In Pakistan, acute surgical illnesses result in 187 deaths per 100,000 of population compared with 164 deaths per 100,000 of population caused by infectious diseases. 3 In 2015, The Lancet Commission on Global Surgery (LCoGS) launched its report ‘‘Global Surgery 2030’’and proposed the National Surgical, Obstetric and Anesthesia Plan (NSOAP) approach as a guide to help committed countries frame their surgical care strategies. 2 In Pakistan, a coordinated, comprehensive, and tailored approach using this framework is required to meet the country’s need for optimizing surgical care delivery.The LCoGS framework builds upon six interdependent domains that provide a platform for NSOAP development: infrastructure, workforce, service delivery, financing, information management, and governance. 4 The LCoGS also proposed six indicators to measure the baseline and monitor the progress of surgical care in a given country. 2 They include: 1) two-hour access to timely essential surgery; 2) surgical, anesthesia, and obstetrics density per 100,000 of population; 3) surgical procedures volume per 100,000 of population; 4) perioperative mortality rates; 5) risk of impoverishing expenditure; and 6) risk of catastrophic expenditure. These indicators have been included in the World Bank Groups’ World Development Indicators repository, 5 thus placing the onus on member countries to focus on surgical care.