Estimating Need, Costs, and Access to Surgical Care in India: Data Synthesis and Modeling Study

Siddhesh Zadey, I conducted the project as part of MSc-GH thesis under the mentorship of Dr. Vissoci.

Project member(s):

  • Siddhesh Zadey

Faculty mentor:

Community partners:

  • Dr. Swati Sonal
    Dr. Sweta Dubey
    Mr. Pushkar Nimkar
    Mr. Rachit Sekhrajka
    And others at Association for Socially Applicable Research (ASAR), India

Estimating Need, Costs, and Access to Surgical Care in India: Data Synthesis and Modeling Study

Project overview

The Lancet Commission on Global Surgery (LCoGS) reported that 5 billion lack timely access to safe and affordable surgical care (Meara et al. 2015). Estimates suggested that over 98% of the billion people in India (South Asia) lacked access (Alkire et al. 2015). Corollarily, one country’s surgical care planning can improve global access by a fifth. The evident need generated momentum for action (e.g. National Surgical Forum 2016 (Lancet Commission on Global Surgery 2016), Karad Consensus Statement (On Behalf Of The Association Of Rural Surgeons Of India-Lancet Commission On Global Surgery Consensus Committee Arsi-LCoGS Consensus Committee 2019), and implementing-LCoGS-India (Raykar et al. 2019) ), however, a clear path to upscaling and improving surgical systems remains elusive. A comprehensive national surgical plan (NSP) will ensure that the surgical need is met. LCoGS and the research thereafter synthesized valuable national or higher-level aggregate estimates for India. The Commission also led to the proposal of global surgery indicators that can help measure and monitor countries’ progress towards essential surgery provision (Raykar et al. 2017; Watters et al. 2018). These indicators can be incorporated in the health-related sustainable development goals (SDGs) for 2030 (Roa et al. 2019). Even so, the 2015 and 2017 Surgical Indicators reports (The Lancet Commission on Global Surgery 2015; The Lancet Commission on Global Surgery 2017) did not have data on any indicator for India, except specialist surgical workforce density, which was collected for 2009 (Holmer et al. 2019).

Lack of reliable and recent subnational data is arguably the biggest bottleneck in India’s progress towards NSP development.  While India is undertaking district and state-level data collection for several health target indicators within the sustainable development goals (SDGs) framework, subnational estimates for surgical care indicators are missing. The current project worked to fill this gap to provide a basis for national surgical care planning and better integrate surgery in India’s developmental vision. 

Our analysis shows that there is a high disparity between rural and urban Indian surgical care necessitating urgent policy attention. The sub-national differences in the surgical need require decentralized policy implementation. India’s new public health insurance can rescue a significant population proportion from catastrophic expenditure on surgery.

Project poster