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Connector proof only; schema field names retained, no individual patient records distributed.","status":"success","httpStatus":200,"attempts":1},{"id":"clinical_trials","name":"Clinical Trials","url":"https://clinicaltrials.gov/api/v2/studies?query.term=AREA%5BBriefTitle%5D%28%22surgical+access%22+OR+%22access+to+surgery%22+OR+%22access+to+surgical+care%22+OR+%22global+surgery%22+OR+%22surgical+capacity%22+OR+%22surgical+workforce%22+OR+%22surgical+care+delivery%22+OR+%22surgical+outreach%22%29+AND+AREA%5BStudyType%5DINTERVENTIONAL&pageSize=6&format=json","accessedAt":"2026-10-19T22:59:56+00:00","licenseNote":"ClinicalTrials.gov public registry data; sponsor submissions are not independent verification of efficacy. See ClinicalTrials.gov terms and conditions.","status":"success","httpStatus":200,"attempts":1}],"evidence":{"classification":"related literature; not model effect estimates","selection":"Three explicit Europe PMC queries on surgical access, capacity and LCoGS indicators, six most-cited results per query, deduplicated. Convenience discovery set, not a systematic review. No relevance or risk-of-bias adjudication.","status":"success","publications":[{"id":"25926087","title":"Global access to surgical care: a modelling study.","authors":"Alkire BC, Raykar NP, Shrime MG, Weiser TG, Bickler SW, Rose JA, Nutt CT, Greenberg SL, Kotagal M, Riesel JN, Esquivel M, Uribe-Leitz T, Molina G, Roy N, Meara JG, Farmer PE.","year":2015,"doi":"10.1016/s2214-109x(15)70115-4","pmid":"25926087","url":"https://europepmc.org/article/MED/25926087","abstract":"Background More than 2 billion people are unable to receive surgical care based on operating theatre density alone. The vision of the Lancet Commission on Global Surgery is universal access to safe, affordable surgical and anaesthesia care when needed. We aimed to estimate the number of individuals worldwide without access to surgical services as defined by the Commission's vision. Methods We modelled access to surgical services in 196 countries with respect to four dimensions: timeliness, surgical capacity, safety, and affordability. We built a chance tree for each country to model the probability of surgical access with respect to each dimension, and from this we constructed a statistical model to estimate the proportion of the population in each country that does not have access to surgical services. We accounted for uncertainty with one-way sensitivity analyses, multiple imputation for missing data, and probabilistic sensitivity analysis. Findings At least 4·8 billion people (95% posterior credible interval 4·6-5·0 [67%, 64-70]) of the world's population do not have access to surgery. The proportion of the population without access varied widely when stratified by epidemiological region: greater than 95% of the population in south Asia and central, eastern, and western sub-Saharan Africa do not have access to care, whereas less than 5% of the population in Australasia, high-income North America, and western Europe lack access. Interpretation Most of the world's population does not have access to surgical care, and access is inequitably distributed. The near absence of access in many low-income and middle-income countries represents a crisis, and as the global health community continues to support the advancement of universal health coverage, increasing access to surgical services will play a central role in ensuring health care for all. Funding None.","journal":"The Lancet. Global health","citedBy":464,"classification":"related literature; not model effect estimates","query":"(TITLE_ABS:\"surgical access\" OR TITLE_ABS:\"access to surgery\" OR TITLE_ABS:\"access to surgical care\") AND (TITLE_ABS:\"global surgery\" OR TITLE_ABS:\"health system\" OR TITLE_ABS:\"low- and middle-income\")","sourceId":"europe_pmc_access"},{"id":"21360305","title":"Systematic review of barriers to surgical care in low-income and middle-income countries.","authors":"Grimes CE, Bowman KG, Dodgion CM, Lavy CB.","year":2011,"doi":"10.1007/s00268-011-1010-1","pmid":"21360305","url":"https://europepmc.org/article/MED/21360305","abstract":"Background There is increasing evidence that lack of facilities, equipment, and expertise in district hospitals across many low- and middle-income countries constitutes a major barrier to accessing surgical care. However, what is less clear, is the extent to which people perceive barriers when trying to access surgical care. Methods PubMed and EMBASE were searched using key words (\"access\" and \"surgery,\" \"barrier\" and \"surgery,\" \"barrier\" and \"access\"), MeSH headings (\"health services availability,\" \"developing countries,\" \"rural population\"), and the subject heading \"health care access.\" Articles were included if they were qualitative and applied to illnesses where the treatment is primarily surgical. Results Key barriers included difficulty accessing surgical services due to distance, poor roads, and lack of suitable transport; lack of local resources and expertise; direct and indirect costs related to surgical care; and fear of undergoing surgery and anesthesia. Conclusions The significance of cultural, financial, and structural barriers pertinent to surgery and their role in wider health care issues are discussed. Immediate action to improve financial and geographic accessibility along with investment in district hospitals is likely to make a significant impact on overcoming access and barrier issues. Further research is needed to identify issues that need to be addressed to close the gap between the care needed and that provided.","journal":"World journal of surgery","citedBy":296,"classification":"related literature; not model effect estimates","query":"(TITLE_ABS:\"surgical access\" OR TITLE_ABS:\"access to surgery\" OR TITLE_ABS:\"access to surgical care\") AND (TITLE_ABS:\"global surgery\" OR TITLE_ABS:\"health system\" OR TITLE_ABS:\"low- and middle-income\")","sourceId":"europe_pmc_access"},{"id":"18797625","title":"The burden of surgical conditions and access to surgical care in low- and middle-income countries.","authors":"Ozgediz D, Jamison D, Cherian M, McQueen K.","year":2008,"doi":"10.2471/blt.07.050435","pmid":"18797625","url":"https://europepmc.org/article/MED/18797625","abstract":"","journal":"Bulletin of the World Health Organization","citedBy":195,"classification":"related literature; not model effect estimates","query":"(TITLE_ABS:\"surgical access\" OR TITLE_ABS:\"access to surgery\" OR TITLE_ABS:\"access to surgical care\") AND (TITLE_ABS:\"global surgery\" OR TITLE_ABS:\"health system\" OR TITLE_ABS:\"low- and middle-income\")","sourceId":"europe_pmc_access"},{"id":"30940982","title":"Estimates of number of children and adolescents without access to surgical care.","authors":"Mullapudi B, Grabski D, Ameh E, Ozgediz D, Thangarajah H, Kling K, Alkire B, Meara JG, Bickler S.","year":2019,"doi":"10.2471/blt.18.216028","pmid":"30940982","url":"https://europepmc.org/article/MED/30940982","abstract":"Objective To estimate how many children and adolescent worldwide do not have access to surgical care. Methods We estimated the number of children and adolescents younger than 19 years worldwide without access to safe, affordable and timely surgical care, by using population data for 2017 from the United Nations and international data on surgical access in 2015. We categorized countries by World Bank country income group and obtained the proportion of the population with no access to surgical care from a study by the  Lancet  Commission on Global Surgery. Findings An estimated 1.7 billion (95% credible interval: 1.6-1.8) children and adolescents worldwide did not have access to surgical care in 2017. Lack of access occurred overwhelmingly in low- and middle-income countries where children and adolescents make up a disproportionately large fraction of the population. Moreover, 453 million children younger than 5 years did not have access to basic life-saving surgical care. According to  Lancet  Commission on Global Surgery criteria, less than 3% of the paediatric population in low-income countries and less than 8% in lower-middle-income countries had access to surgical care. Conclusion There were substantial gaps in the availability of surgical services for children worldwide, particularly in low- and middle-income countries. Future research should focus on developing specific measures for assessing paediatric surgical access, delivery and outcomes and on clarifying how limited surgical access in the poorest parts of the world affects child health, especially mortality in children younger than 5 years.","journal":"Bulletin of the World Health Organization","citedBy":142,"classification":"related literature; not model effect estimates","query":"(TITLE_ABS:\"surgical access\" OR TITLE_ABS:\"access to surgery\" OR TITLE_ABS:\"access to surgical care\") AND (TITLE_ABS:\"global surgery\" OR TITLE_ABS:\"health system\" OR TITLE_ABS:\"low- and middle-income\")","sourceId":"europe_pmc_access"},{"id":"27351714","title":"Bellwether Procedures for Monitoring and Planning Essential Surgical Care in Low- and Middle-Income Countries: Caesarean Delivery, Laparotomy, and Treatment of Open Fractures.","authors":"O'Neill KM, Greenberg SL, Cherian M, Gillies RD, Daniels KM, Roy N, Raykar NP, Riesel JN, Spiegel D, Watters DA, Gruen RL.","year":2016,"doi":"10.1007/s00268-016-3614-y","pmid":"27351714","url":"https://europepmc.org/article/MED/27351714","abstract":"Background Surgical conditions represent a significant proportion of the global burden of disease, and therefore, surgery is an essential component of health systems. Achieving universal health coverage requires effective monitoring of access to surgery. However, there is no widely accepted standard for the required capabilities of a first-level hospital. We aimed to determine whether a group of operations could be used to describe the delivery of essential surgical care. Methods We convened an expert panel to identify procedures that might indicate the presence of resources needed to treat an appropriate range of surgical conditions at first-level hospitals. Using data from the World Health Organization Emergency and Essential Surgical Care Global database, collected using the WHO Situational Analysis Tool (SAT), we analysed whether the ability to perform each of these procedures-which we term \"bellwether procedures\"-was associated with performing a full range of essential surgical procedures. Findings The ability to perform caesarean delivery, laparotomy, and treatment of open fracture was closely associated with performing all obstetric, general, basic, emergency, and orthopaedic procedures (p  Interpretation Caesarean delivery, laparotomy, and treatment of open fractures should be standard procedures performed at first-level hospitals. With further validation in other populations, local managers and health ministries may find this useful as a benchmark for what first-level hospitals can and should be able to perform on a 24/7 basis in order to ensure delivery of emergency and essential surgical care to their population. Those procedures which did not correlate with the bellwether procedures can be referred to a specialized centre or collected for treatment by a visiting specialist team.","journal":"World journal of surgery","citedBy":98,"classification":"related literature; not model effect estimates","query":"(TITLE_ABS:\"surgical access\" OR TITLE_ABS:\"access to surgery\" OR TITLE_ABS:\"access to surgical care\") AND (TITLE_ABS:\"global surgery\" OR TITLE_ABS:\"health system\" OR TITLE_ABS:\"low- and middle-income\")","sourceId":"europe_pmc_access"},{"id":"23217895","title":"The burden of pediatric surgical conditions in low and middle income countries: a call to action.","authors":"Ozgediz D, Poenaru D.","year":2012,"doi":"10.1016/j.jpedsurg.2012.09.030","pmid":"23217895","url":"https://europepmc.org/article/MED/23217895","abstract":"Recently, the role of surgery in global health has gained greater attention, although pediatric surgery has received little specific emphasis. This paper highlights pediatric surgical conditions as a part of global public health, and identifies gaps in knowledge and possible areas of action for the global pediatric surgical community. The burden of disease concept is discussed with examples of its application to pediatric surgery, and further information required to improve measurement of the global burden of pediatric surgical conditions. In addition, selected tools to measure access to surgical care and the unmet need for surgery in low and middle-income countries (LMICs) are reviewed, with recent innovative approaches and other possible adaptations to pediatric surgery. Finally, some of the strategies used to improve access to care for pediatric surgical conditions are discussed, with possible future directions.","journal":"Journal of pediatric surgery","citedBy":82,"classification":"related literature; not model effect estimates","query":"(TITLE_ABS:\"surgical access\" OR TITLE_ABS:\"access to surgery\" OR TITLE_ABS:\"access to surgical care\") AND (TITLE_ABS:\"global surgery\" OR TITLE_ABS:\"health system\" OR TITLE_ABS:\"low- and middle-income\")","sourceId":"europe_pmc_access"},{"id":"29701548","title":"Global neurosurgery: the current capacity and deficit in the provision of essential neurosurgical care. Executive Summary of the Global Neurosurgery Initiative at the Program in Global Surgery and Social Change.","authors":"Dewan MC, Rattani A, Fieggen G, Arraez MA, Servadei F, Boop FA, Johnson WD, Warf BC, Park KB.","year":2019,"doi":"10.3171/2017.11.jns171500","pmid":"29701548","url":"https://europepmc.org/article/MED/29701548","abstract":"Objective Worldwide disparities in the provision of surgical care result in otherwise preventable disability and death. There is a growing need to quantify the global burden of neurosurgical disease specifically, and the workforce necessary to meet this demand. Methods Results from a multinational collaborative effort to describe the global neurosurgical burden were aggregated and summarized. First, country registries, third-party modeled data, and meta-analyzed published data were combined to generate incidence and volume figures for 10 common neurosurgical conditions. Next, a global mapping survey was performed to identify the number and location of neurosurgeons in each country. Finally, a practitioner survey was conducted to quantify the proportion of disease requiring surgery, as well as the median number of neurosurgical cases per annum. The neurosurgical case deficit was calculated as the difference between the volume of essential neurosurgical cases and the existing neurosurgical workforce capacity. Results Every year, an estimated 22.6 million patients suffer from neurological disorders or injuries that warrant the expertise of a neurosurgeon, of whom 13.8 million require surgery. Traumatic brain injury, stroke-related conditions, tumors, hydrocephalus, and epilepsy constitute the majority of essential neurosurgical care worldwide. Approximately 23,300 additional neurosurgeons are needed to address more than 5 million essential neurosurgical cases-all in low- and middle-income countries-that go unmet each year. There exists a gross disparity in the allocation of the surgical workforce, leaving large geographic treatment gaps, particularly in Africa and Southeast Asia. Conclusions Each year, more than 5 million individuals suffering from treatable neurosurgical conditions will never undergo therapeutic surgical intervention. Populations in Africa and Southeast Asia, where the proportion of neurosurgeons to neurosurgical disease is critically low, are especially at risk. Increasing access to essential neurosurgical care in low- and middle-income countries via neurosurgical workforce expansion as part of surgical system strengthening is necessary to prevent severe disability and death for millions with neurological disease.","journal":"Journal of neurosurgery","citedBy":323,"classification":"related literature; not model effect estimates","query":"(TITLE_ABS:\"surgical capacity\" OR TITLE_ABS:\"surgical workforce\") AND (TITLE_ABS:financing OR TITLE_ABS:access OR TITLE_ABS:\"health system\")","sourceId":"europe_pmc_capacity"},{"id":"27670090","title":"Quality of basic maternal care functions in health facilities of five African countries: an analysis of national health system surveys.","authors":"Kruk ME, Leslie HH, Verguet S, Mbaruku GM, Adanu RMK, Langer A.","year":2016,"doi":"10.1016/s2214-109x(16)30180-2","pmid":"27670090","url":"https://europepmc.org/article/MED/27670090","abstract":"Background Global efforts to increase births at health-care facilities might not reduce maternal or newborn mortality if quality of care is insufficient. However, little systematic evidence exists for the quality at health facilities caring for women and newborn babies in low-income countries. We analysed the quality of basic maternal care functions and its association with volume of deliveries and surgical capacity in health-care facilities in five sub-Saharan African countries. Methods In this analysis, we combined nationally representative health system surveys (Service Provision Assessments by the Demographic and Health Survery Programme) with data for volume of deliveries and quality of delivery care from Kenya, Namibia, Rwanda, Tanzania, and Uganda. We measured the quality of basic maternal care functions in delivery facilities using an index of 12 indicators of structure and processes of care, including infrastructure and use of evidence-based routine and emergency care interventions. We regressed the quality index on volume of births and confounders (public or privately managed, availability of antiretroviral therapy services, availability of skilled staffing, and country) stratified by facility type: primary (no caesarean capacity) or secondary (has caesarean capacity) care facilities. The Harvard University Human Research Protection Program approved this analysis as exempt from human subjects review. Findings The national surveys were completed between April, 2006, and May, 2010. Our sample consisted of 1715 (93%) of 1842 health-care facilities that provided normal delivery service, after exclusion of facilities with missing (n=126) or invalid (n=1) data. 1511 (88%) study facilities (site of 276 965 [44%] of 622 864 facility births) did not have caesarean section capacity (primary care facilities). Quality of basic maternal care functions was substantially lower in primary (index score 0·38) than secondary care facilities (0·77). Low delivery volume was consistently associated with poor quality, with differences in quality between the lowest versus highest volume facilities of -0·22 (95% CI -0·26 to -0·19) in primary care facilities and -0·17 (-0·21 to -0·11) in secondary care facilities. Interpretation More than 40% of facility deliveries in these five African countries occurred in primary care facilities, which scored poorly on basic measures of maternal care quality. Facilities with caesarean section capacity, particularly those with birth volumes higher than 500 per year, had higher scores for maternal care quality. Low-income and middle-income countries should systematically assess and improve the quality of delivery care in health facilities to accelerate reduction of maternal and newborn deaths. Funding None.","journal":"The Lancet. Global health","citedBy":217,"classification":"related literature; not model effect estimates","query":"(TITLE_ABS:\"surgical capacity\" OR TITLE_ABS:\"surgical workforce\") AND (TITLE_ABS:financing OR TITLE_ABS:access OR TITLE_ABS:\"health system\")","sourceId":"europe_pmc_capacity"},{"id":"19221322","title":"Quantifying surgical capacity in Sierra Leone: a guide for improving surgical care.","authors":"Kingham TP, Kamara TB, Cherian MN, Gosselin RA, Simkins M, Meissner C, Foray-Rahall L, Daoh KS, Kabia SA, Kushner AL.","year":2009,"doi":"10.1001/archsurg.2008.540","pmid":"19221322","url":"https://europepmc.org/article/MED/19221322","abstract":"Hypothesis Lack of access to surgical care is a public health crisis in developing countries. There are few data that describe a nation's ability to provide surgical care. This study combines information quantifying the infrastructure, human resources, interventions (ie, procedures), emergency equipment and supplies for resuscitation, and surgical procedures offered at many government hospitals in Sierra Leone. Setting Site visits were performed in 2008 at 10 of the 17 government civilian hospitals in Sierra Leone. Main outcome measures The World Health Organization's Tool for Situational Analysis to Assess Emergency and Essential Surgical Care was used to assess surgical capacity. Results There was a paucity of electricity, running water, oxygen, and fuel at the government hospitals in Sierra Leone. There were only 10 Sierra Leonean surgeons practicing in the surveyed government hospitals. Many procedures performed at most of the hospitals were cesarean sections, hernia repairs, and appendectomies. There were few supplies at any of the hospitals, forcing patients to provide their own. There was a disparity between conditions at the government hospitals and those at the private and mission hospitals. Conclusion There are severe shortages in all aspects of infrastructure, personnel, and supplies required for delivering surgical care in Sierra Leone. While it will be difficult to improve the infrastructure of government hospitals, training additional personnel to deliver safe surgical care is possible. The situational analysis tool is a valuable mechanism to quantify a nation's surgical capacity. It provides the background data that have been lacking in the discussion of surgery as a public health problem and will assist in gauging the effectiveness of interventions to improve surgical infrastructure and care.","journal":"Archives of surgery (Chicago, Ill. : 1960)","citedBy":167,"classification":"related literature; not model effect estimates","query":"(TITLE_ABS:\"surgical capacity\" OR TITLE_ABS:\"surgical workforce\") AND (TITLE_ABS:financing OR TITLE_ABS:access OR TITLE_ABS:\"health system\")","sourceId":"europe_pmc_capacity"},{"id":"24218153","title":"Shortage of doctors, shortage of data: a review of the global surgery, obstetrics, and anesthesia workforce literature.","authors":"Hoyler M, Finlayson SR, McClain CD, Meara JG, Hagander L.","year":2014,"doi":"10.1007/s00268-013-2324-y","pmid":"24218153","url":"https://europepmc.org/article/MED/24218153","abstract":"Introduction The global surgery workforce is in crisis in many low- and middle-income countries (LMICs). The shortage of surgery, obstetrics, and anesthesia providers is an important cause of the unmet need for surgical care in LMICs. The goal of this paper is to summarize the available literature about surgical physicians in LMICs and to describe ongoing initiatives to supplement the existing surgical workforce data. Methods We performed a systematic search and literature review of the English-language literature regarding the number of surgeons, obstetrician-gynecologists, and anesthesiologists practicing in LMICs. Results Literature describing the number of surgeons, obstetricians, and anesthesiologists practicing in LMICs represents a small minority of LMICs, and indicates consistently low levels of surgical physicians. Our literature search yielded comprehensive data for only six countries. No national data were found for 23 of the 57 countries considered by the World Health Organization (WHO) to be in health workforce 'crisis.' Across LMICs, general surgeon density ranged from 0.13 to 1.57 per 100,000 population, obstetrician density ranged from 0.042 to 12.5 per 100,000, and anesthesiologist density ranged from 0 to 4.9 per 100,000. Total anesthesiologist, obstetrician, and surgeon density was significantly correlated with gross domestic product (GDP) per capita (r (2) = 0.097, p = 0.0002). Conclusion The global surgery workforce is in crisis, yet is poorly characterized by the current English-language literature. There is a critical need for systematically collected, national-level data regarding surgery providers in LMICs to guide improvements in surgery access and care. The Harvard Global Surgery Workforce Initiative and the WHO global surgical workforce database are working to address this need by surveying Ministries of Health and surgical professional organizations around the world.","journal":"World journal of surgery","citedBy":165,"classification":"related literature; not model effect estimates","query":"(TITLE_ABS:\"surgical capacity\" OR TITLE_ABS:\"surgical workforce\") AND (TITLE_ABS:financing OR TITLE_ABS:access OR TITLE_ABS:\"health system\")","sourceId":"europe_pmc_capacity"},{"id":"19730238","title":"The impending shortage and the estimated cost of training the future surgical workforce.","authors":"Williams TE, Satiani B, Thomas A, Ellison EC.","year":2009,"doi":"10.1097/sla.0b013e3181b6c90b","pmid":"19730238","url":"https://europepmc.org/article/MED/19730238","abstract":"Objectives To estimate the workforce needed by 2030 in 7 surgical specialties to serve a population of 364 million people and to quantify the cost associated with training additional surgeons. Materials and methods A review of the certificates granted in otolaryngology, orthopedic surgery, thoracic surgery, obstetrics and gynecology, neurosurgery, urology, and general surgery was conducted. Using a population-based algorithm, we extended the results of Richard Cooper's pioneering work to these fields of surgery. The assumptions were unchanged physician to population ratio, 30 years in practice from completion of residency to retirement, and no revision of the Balanced Budget Act of 1997, and therefore no additional residency positions offered. Per resident expenses were estimated annually at $80,000, including salaries, benefits, and other direct medical education costs. Results/conclusions (1) There will not be enough surgeons in the 7 surgical specialties studied. (2) We will have to train more than 100,000 surgeons by 2030 to maintain access for our citizens at an annual cost of almost $2 Billion and total cost of about $37 billion. (3) To train the extra needed surgical workforce will cost an additional $10 Billion. (4) To do this, the Balanced Budget Act of 1997 must be revised to permit more residents to be trained in the United States or other alternatives explored.","journal":"Annals of surgery","citedBy":135,"classification":"related literature; not model effect estimates","query":"(TITLE_ABS:\"surgical capacity\" OR TITLE_ABS:\"surgical workforce\") AND (TITLE_ABS:financing OR TITLE_ABS:access OR TITLE_ABS:\"health system\")","sourceId":"europe_pmc_capacity"},{"id":"34415914","title":"Global surgery, obstetric, and anaesthesia indicator definitions and reporting: An Utstein consensus report.","authors":"Davies JI, Gelb AW, Gore-Booth J, Martin J, Mellin-Olsen J, Åkerman C, Ameh EA, Biccard BM, Braut GS, Chu KM, Derbew M, Ersdal HL, Guzman JM, Hagander L, Haylock-Loor C, Holmer H, Johnson W, Juran S, Kassebaum NJ, Laerdal T, Leather AJM, Lipnick MS, Ljungman D, Makasa EM, Meara JG, Newton MW, Østergaard D, Reynolds T, Romanzi LJ, Santhirapala V, Shrime MG, Søreide K, Steinholt M, Suzuki E, Varallo JE, Visser GHA, Watters D, Weiser TG.","year":2021,"doi":"10.1371/journal.pmed.1003749","pmid":"34415914","url":"https://europepmc.org/article/MED/34415914","abstract":"Background Indicators to evaluate progress towards timely access to safe surgical, anaesthesia, and obstetric (SAO) care were proposed in 2015 by the Lancet Commission on Global Surgery. These aimed to capture access to surgery, surgical workforce, surgical volume, perioperative mortality rate, and catastrophic and impoverishing financial consequences of surgery. Despite being rapidly taken up by practitioners, data points from which to derive the indicators were not defined, limiting comparability across time or settings. We convened global experts to evaluate and explicitly define-for the first time-the indicators to improve comparability and support achievement of 2030 goals to improve access to safe affordable surgical and anaesthesia care globally. Methods and findings The Utstein process for developing and reporting guidelines through a consensus building process was followed. In-person discussions at a 2-day meeting were followed by an iterative process conducted by email and virtual group meetings until consensus was reached. The meeting was held between June 16 to 18, 2019; discussions continued until August 2020. Participants consisted of experts in surgery, anaesthesia, and obstetric care, data science, and health indicators from high-, middle-, and low-income countries. Considering each of the 6 indicators in turn, we refined overarching descriptions and agreed upon data points needed for construction of each indicator at current time (basic data points), and as each evolves over 2 to 5 (intermediate) and >5 year (full) time frames. We removed one of the original 6 indicators (one of 2 financial risk protection indicators was eliminated) and refined descriptions and defined data points required to construct the 5 remaining indicators: geospatial access, workforce, surgical volume, perioperative mortality, and catastrophic expenditure. A strength of the process was the number of people from global institutes and multilateral agencies involved in the collection and reporting of global health metrics; a limitation was the limited number of participants from low- or middle-income countries-who only made up 21% of the total attendees. Conclusions To track global progress towards timely access to quality SAO care, these indicators-at the basic level-should be implemented universally as soon as possible. Intermediate and full indicator sets should be achieved by all countries over time. Meanwhile, these evolutions can assist in the short term in developing national surgical plans and collecting more detailed data for research studies.","journal":"PLoS medicine","citedBy":59,"classification":"related literature; not model effect estimates","query":"TITLE_ABS:\"Lancet Commission on Global Surgery\" AND TITLE_ABS:indicators","sourceId":"europe_pmc_indicators"},{"id":"29225948","title":"Collecting data for global surgical indicators: a collaborative approach in the Pacific Region.","authors":"Guest GD, McLeod E, Perry WRG, Tangi V, Pedro J, Ponifasio P, Hedson J, Tudravu J, Pikacha D, Vreede E, Leodoro B, Tapaua N, Kong J, Oten B, Teapa D, Korin S, Wilson L, Mesol S, Tuneti K, Meara JG, Watters DA.","year":2017,"doi":"10.1136/bmjgh-2017-000376","pmid":"29225948","url":"https://europepmc.org/article/MED/29225948","abstract":"In 2015, the Lancet Commission on Global Surgery (LCoGS) recommended six surgical metrics to enable countries to measure their surgical and anaesthesia care delivery. These indicators have subsequently been accepted by the World Bank for inclusion in the World Development Indicators. With support from the Royal Australasian College of Surgeons and the Pacific Islands Surgical Association, 14 South Pacific countries collaborated to collect the first four of six LCoGS indicators. Thirteen countries collected all four indicators over a 6-month period from October 2015 to April 2016. Australia and New Zealand exceeded the recommended LCoGS target for all four indicators. Only 5 of 13 countries (38%) achieved 2-hour access for at least 80% of their population, with a range of 20% (Papua New Guinea and Solomon Islands) to over 65% (Fiji and Samoa). Five of 13 (38%) countries met the target surgical volume of 5000 procedures per 100 000 population, with six performing less than 1600. Four of 14 (29%) countries had at least 20 surgical, anaesthesia and obstetric providers in their workforce per 100 000 population, with a range of 0.9 (Timor Leste) to 18.5 (Tuvalu). Perioperative mortality rate was reported by 13 of 14 countries, and ranged from 0.11% to 1.0%. We believe it is feasible to collect global surgery indicators across the South Pacific, a diverse geographical region encompassing high-income and low-income countries. Such metrics will allow direct comparison between similar nations, but more importantly provide baseline data that providers and politicians can use in advocacy national health planning.","journal":"BMJ global health","citedBy":57,"classification":"related literature; not model effect estimates","query":"TITLE_ABS:\"Lancet Commission on Global Surgery\" AND TITLE_ABS:indicators","sourceId":"europe_pmc_indicators"},{"id":"36328042","title":"Elective surgery system strengthening: development, measurement, and validation of the surgical preparedness index across 1632 hospitals in 119 countries.","authors":"NIHR Global Health Unit on Global Surgery, COVIDSurg Collaborative.","year":2022,"doi":"10.1016/s0140-6736(22)01846-3","pmid":"36328042","url":"https://europepmc.org/article/MED/36328042","abstract":"Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index to support local elective surgical system strengthening and address growing backlogs. Methods First, we performed an international consultation through a four-stage consensus process to develop a multidomain index for hospital-level assessment (surgical preparedness index; SPI). Second, we measured surgical preparedness across a global network of hospitals in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) to explore the distribution of the SPI at national, subnational, and hospital levels. Finally, using COVID-19 as an example of an external system shock, we compared hospitals' SPI to their planned surgical volume ratio (SVR; ie, operations for which the decision for surgery was made before hospital admission), calculated as the ratio of the observed surgical volume over a 1-month assessment period between June 6 and Aug 5, 2021, against the expected surgical volume based on hospital administrative data from the same period in 2019 (ie, a pre-pandemic baseline). A linear mixed-effects regression model was used to determine the effect of increasing SPI score. Findings In the first phase, from a longlist of 103 candidate indicators, 23 were prioritised as core indicators of elective surgical system preparedness by 69 clinicians (23 [33%] women; 46 [67%] men; 41 from HICs, 22 from MICs, and six from LICs) from 32 countries. The multidomain SPI included 11 indicators on facilities and consumables, two on staffing, two on prioritisation, and eight on systems. Hospitals were scored from 23 (least prepared) to 115 points (most prepared). In the second phase, surgical preparedness was measured in 1632 hospitals by 4714 clinicians from 119 countries. 745 (45·6%) of 1632 hospitals were in MICs or LICs. The mean SPI score was 84·5 (95% CI 84·1-84·9), which varied between HIC (88·5 [89·0-88·0]), MIC (81·8 [82·5-81·1]), and LIC (66·8 [64·9-68·7]) settings. In the third phase, 1217 (74·6%) hospitals did not maintain their expected SVR during the COVID-19 pandemic, of which 625 (51·4%) were from HIC, 538 (44·2%) from MIC, and 54 (4·4%) from LIC settings. In the mixed-effects model, a 10-point increase in SPI corresponded to a 3·6% (95% CI 3·0-4·1; p Interpretation The SPI contains 23 indicators that are globally applicable, relevant across different system stressors, vary at a subnational level, and are collectable by front-line teams. In the case study of COVID-19, a higher SPI was associated with an increased planned surgical volume ratio independent of country income status, COVID-19 burden, and hospital type. Hospitals should perform annual self-assessment of their surgical preparedness to identify areas that can be improved, create resilience in local surgical systems, and upscale capacity to address elective surgery backlogs. Funding National Institute for Health Research (NIHR) Global Health Research Unit on Global Surgery, NIHR Academy, Association of Coloproctology of Great Britain and Ireland, Bowel Research UK, British Association of Surgical Oncology, British Gynaecological Cancer Society, and Medtronic.","journal":"Lancet (London, England)","citedBy":56,"classification":"related literature; not model effect estimates","query":"TITLE_ABS:\"Lancet Commission on Global Surgery\" AND TITLE_ABS:indicators","sourceId":"europe_pmc_indicators"},{"id":"28589025","title":"Assessing the Brazilian surgical system with six surgical indicators: a descriptive and modelling study.","authors":"Massenburg BB, Saluja S, Jenny HE, Raykar NP, Ng-Kamstra J, Guilloux AGA, Scheffer MC, Meara JG, Alonso N, Shrime MG.","year":2017,"doi":"10.1136/bmjgh-2016-000226","pmid":"28589025","url":"https://europepmc.org/article/MED/28589025","abstract":"Background Brazil boasts a health scheme that aspires to provide universal coverage, but its surgical system has rarely been analysed. In an effort to strengthen surgical systems worldwide, the Lancet Commission on Global Surgery proposed a collection of 6 standardised indicators: 2-hour access to surgery, surgical workforce density, surgical volume, perioperative mortality rate (POMR) and protection against impoverishing and catastrophic expenditure. This study aims to characterise the Brazilian surgical health system with these newly devised indicators while gaining understanding on the complexity of the indicators themselves. Methods Using Brazil's national healthcare database, commonly reported healthcare variables were used to calculate or simulate the 6 surgical indicators. Access to surgery was calculated using hospital locations, surgical workforce density was calculated using locations of surgeons, anaesthesiologists and obstetricians (SAO), and surgical volume and POMR were identified with surgical procedure codes. The rates of protection against impoverishing and catastrophic expenditure were modelled using cost of surgical inpatient hospitalisations and a γ distribution of incomes based on Gini and gross domestic product/capita. Findings In 2014, SAO density was 34.7/100 000 population, surgical volume was 4433 procedures/100 000 people and POMR was 1.71%. 79.4% of surgical patients were protected against impoverishing expenditure and 84.6% were protected against catastrophic expenditure due to surgery each year. 2-hour access to surgery was not able to be calculated from national health data, but a proxy measure suggested that 97.2% of the population has 2-hour access to a hospital that may be able to provide surgery. Geographic disparities were seen in all indicators. Interpretation Brazil's public surgical system meets several key benchmarks. Geographic disparities, however, are substantial and raise concerns of equity. Policies should focus on stimulating appropriate geographic allocation of the surgical workforce and better distribution of surgical volume. In some cases, where benchmarks for each indicator are met, supplemental analysis can further inform our understanding of health systems. This measured and systematic evaluation should be encouraged for all nations seeking to better understand their surgical systems.","journal":"BMJ global health","citedBy":52,"classification":"related literature; not model effect estimates","query":"TITLE_ABS:\"Lancet Commission on Global Surgery\" AND TITLE_ABS:indicators","sourceId":"europe_pmc_indicators"},{"id":"32895051","title":"Measuring the availability and geographical accessibility of maternal health services across sub-Saharan Africa.","authors":"Wigley AS, Tejedor-Garavito N, Alegana V, Carioli A, Ruktanonchai CW, Pezzulo C, Matthews Z, Tatem AJ, Nilsen K.","year":2020,"doi":"10.1186/s12916-020-01707-6","pmid":"32895051","url":"https://europepmc.org/article/MED/32895051","abstract":"Background With universal health coverage a key component of the 2030 Sustainable Development Goals, targeted monitoring is crucial for reducing inequalities in the provision of services. However, monitoring largely occurs at the national level, masking sub-national variation. Here, we estimate indicators for measuring the availability and geographical accessibility of services, at national and sub-national levels across sub-Saharan Africa, to show how data at varying spatial scales and input data can considerably impact monitoring outcomes. Methods Availability was estimated using the World Health Organization guidelines for monitoring emergency obstetric care, defined as the number of hospitals per 500,000 population. Geographical accessibility was estimated using the Lancet Commission on Global Surgery, defined as the proportion of pregnancies within 2 h of the nearest hospital. These were calculated using geo-located hospital data for sub-Saharan Africa, with their associated travel times, along with small area estimates of population and pregnancies. The results of the availability analysis were then compared to the results of the accessibility analysis, to highlight differences between the availability and geographical accessibility of services. Results Despite most countries meeting the targets at the national level, we identified substantial sub-national variation, with 58% of the countries having at least one administrative unit not meeting the availability target at province level and 95% at district level. Similarly, 56% of the countries were found to have at least one province not meeting the accessibility target, increasing to 74% at the district level. When comparing both availability and accessibility within countries, most countries were found to meet both targets; however sub-nationally, many countries fail to meet one or the other. Conclusion While many of the countries met the targets at the national level, we found large within-country variation. Monitoring under the current guidelines, using national averages, can mask these areas of need, with potential consequences for vulnerable women and children. It is imperative therefore that indicators for monitoring the availability and geographical accessibility of health care reflect this need, if targets for universal health coverage are to be met by 2030.","journal":"BMC medicine","citedBy":49,"classification":"related literature; not model effect estimates","query":"TITLE_ABS:\"Lancet Commission on Global Surgery\" AND TITLE_ABS:indicators","sourceId":"europe_pmc_indicators"},{"id":"32353317","title":"Use of the six core surgical indicators from the Lancet Commission on Global Surgery in Colombia: a situational analysis.","authors":"Hanna JS, Herrera-Almario GE, Pinilla-Roncancio M, Tulloch D, Valencia SA, Sabatino ME, Hamilton C, Rehman SU, Mendoza AK, Gómez Bernal LC, Salas MFM, Navarro MAP, Nemoyer R, Scott M, Pardo-Bayona M, Rubiano AM, Ramirez MV, Londoño D, Dario-Gonzalez I, Gracias V, Peck GL.","year":2020,"doi":"10.1016/s2214-109x(20)30090-5","pmid":"32353317","url":"https://europepmc.org/article/MED/32353317","abstract":"Background Surgical, anaesthetic, and obstetric (SAO) health-care system strengthening is needed to address the emergency and essential surgical care that approximately 5 billion individuals lack globally. To our knowledge, a complete, non-modelled national situational analysis based on the Lancet Commission on Global Surgery surgical indicators has not been done. We aimed to undertake a complete situation analysis of SAO system preparedness, service delivery, and financial risk protection using the core surgical indicators proposed by the Commission in Colombia, an upper-middle-income country. Methods Data to inform the six core surgical system indicators were abstracted from the Colombian national health information system and the most recent national health survey done in 2007. Geographical access to a Bellwether hospital (defined as a hospital capable of providing essential and emergency surgery) within 2 h was assessed by determining 2 h drive time boundaries around Bellwether facilities and the population within and outside these boundaries. Physical 2 h access to a Bellwether was determined by the presence of a motor vehicle suitable for individual transportation. The Department Administrativo Nacional de Estadística population projection for 2016 and 2018 was used to calculate the SAO provider density. Total operative volume was calculated for 2016 and expressed nationally per 100 000 population. The total number of postoperative deaths that occurred within 30 days of a procedure was divided by the total operative volume to calculate the all-cause, non-risk-adjusted postoperative mortality. The proportion of the population subject to impoverishing costs was calculated by subtracting the baseline number of impoverished individuals from those who fell below the poverty line once out-of-pocket payments were accounted for. Individuals who incurred out-of-pocket payments that were more than 10% of their annual household income were considered to have experienced catastrophic expenditure. Using GIS mapping, SAO system preparedness, service delivery, and cost protection were also contextualised by socioeconomic status. Findings In 2016, at least 7·1 million people (15·1% of the population) in Colombia did not have geographical access to SAO services within a 2 h driving distance. SAO provider density falls short of the Commission's minimum target of 20 providers per 100 000 population, at an estimated density of 13·7 essential SAO health-care providers per 100 000 population in 2018. Lower socioeconomic status of a municipality, as indicated by proportion of people enrolled in the subsidised insurance regime, was associated with a smaller proportion of the population in the municipality being within 2 h of a Bellwether facility, and the most socioeconomically disadvantaged municipalities often had no SAO providers. Furthermore, Colombian providers appear to be working at or beyond capacity, doing 2690-3090 procedures per 100 000 population annually, but they have maintained a relatively low median postoperative mortality of 0·74% (IQR 0·48-0·84). Finally, out-of-pocket expenses for indirect health-care costs were a key barrier to accessing surgical care, prompting 3·1 million (6·4% of the population) individuals to become impoverished and 9·5 million (19·4% of the population) individuals to incur catastrophic expenditures in 2007. Interpretation We did a non-modelled, indicator-based situation analysis of the Colombian SAO system, finding that it has not yet met, but is working towards achieving, the targets set by the Lancet Commission on Global Surgery. The observed interdependence of these indicators and correlation with socioeconomic status are consistent with well recognised factors and outcomes of social, health, and health-care inequity. The internal consistency observed in Colombia's situation analysis validates the use of the indicators and has now informed development of an early national SAO plan in Colombia, to set a data-informed stage for implementation and evaluation of timely, safe, and affordable SAO health care, within the National Public Health Decennial Plan, which is due in 2022. Funding Zoll Medical.","journal":"The Lancet. Global health","citedBy":45,"classification":"related literature; not model effect estimates","query":"TITLE_ABS:\"Lancet Commission on Global Surgery\" AND TITLE_ABS:indicators","sourceId":"europe_pmc_indicators"}]},"trials":{"classification":"registered studies; not evidence of efficacy or surgery relevance","selection":"First six ClinicalTrials.gov API results for interventional studies with surgical access, capacity, workforce or delivery terms in the title. No country filter; registry coverage of health-system interventions is thin.","status":"success","studies":[{"nctId":"NCT06210204","title":"Improving Access to Surgical Care: Safety, Efficacy, and Satisfaction With Postoperative Telehealth","status":"NOT_YET_RECRUITING","phase":["NA"],"studyType":"INTERVENTIONAL","briefSummary":"Background: A quarter of US Veterans reside in rural communities and are significantly older than their urban counterparts. Providing timely access to care is especially important in this older, independent and medically complex cohort. Virtual care, by phone or video, has improved access to care in non-surgical specialties; however, its utilization in surgery is less than 10% and has continued to decline after the COVID pandemic. Recent studies in surgical patients have demonstrated no difference in missed adverse events, emergency department visits or readmissions; but these data are limited to routine, low-risk procedures in large, urban centers. Routine telehealth for low and high-complexity surgery could be of particular benefit to rural patients by reducing travel challenges, costs, improving scheduling flexibility and reinforcing independence. The hypothesis is that routine telehealth follow-up for elective surgical procedures, of all complexity, will provide equivalent outcomes and improved patient satisfaction and access in comparison to face-to-face follow-up.\n\nSignificance: VA Integrated Service Network (VISN) 19 is the largest geographic region in the VA system and includes four intermediate/complex VA Medical Centers (VAMC) serving rural and urban patients across 10 states. Almost 4000 unique patients are seen annually at these 4 centers resulting in 2600 operations and over 16,000 patient encounters. Another 2500 unique patients are referred to community care (CC) at a cost of over $5 million in FY23. Improving access through telehealth in this largely rural VISN will positively impact Veterans and reduce community care expenditures in addition to improving patient and provider satisfaction.\n\nInnovation \\& Impact: There are currently no funded or published randomized trials evaluating the efficacy of telehealth in providing postoperative surgical care to rural patients. The proposal will provide robust, Level 1 data confirming the safety of postoperative telehealth care. In addition, the investigators will provide the only evaluation of both the patient and provider experience in rural, surgical telehealth care. They will leverage the largest geographic region, VISN19, to ensure broad applicability of findings to rural and urban Veterans.\n\nSpecific Aims: Aim 1: Evaluate the safety of postoperative telehealth in rural and urban Veterans. Aim 2: Evaluate the usability and patient satisfaction of telehealth in comparison to in-person postoperative follow-up. Aim 3: Evaluate the usability and provider satisfaction of telehealth in comparison to in-person follow-up.\n\nMethodology: Patients undergoing elective general surgical procedures (both inpatient and outpatient) at four VA medical centers (Denver, CO; Oklahoma City, OK; Muskogee, OK; Salt Lake City, UT) in VISN 19 will be randomized to post-operative follow-up in person or via telehealth. Patients who discharge with drains or wound vacuum therapy, permanent suture or staples will be excluded. Aim 1: 30-day morbidity, missed adverse events (complications that may have been recognized with in-person follow-up), 30-day mortality, 30-day readmission, and 30-day ED visits will be compared evaluated to determine safety of telehealth follow-up. Aim 2: Post-operative surveys at 6 weeks after surgery will quantify acceptability of telehealth follow-up via the standardized Telehealth Usability Questionnaire; satisfaction and usability will be compared via the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery survey (S-CAHPS) between the groups. Patients will also be characterized by baseline demographics, distance to nearest facility, socioeconomic vulnerability and procedure type to further define optimal cohorts for future telehealth participation and implementation. Aim 3: Usability and satisfaction for Providers will be determined by self-developed survey. Bi-monthly responses will be recorded to define trends and optimize future implementation.\n\nNext Steps/Implementation: If safe and acceptable to patients and providers, standardization for telehealth follow-up after surgery can be implemented nation-wide to improve access to care and satisfaction.","url":"https://clinicaltrials.gov/study/NCT06210204","countries":["United States"],"locations":[{"facility":"Rocky Mountain Regional VAMC","city":"Aurora","country":"United States"},{"facility":"Eastern Oklahoma VAMC","city":"Muskogee","country":"United States"},{"facility":"Oklahoma CIty VAMC","city":"Oklahoma City","country":"United States"},{"facility":"Salt Lake City VAMC","city":"Salt Lake City","country":"United States"}],"sourceId":"clinical_trials","lastUpdate":"2024-01-18"},{"nctId":"NCT03140059","title":"Comparison Between Surgical Access and Repeated Applications of APDT","status":"UNKNOWN","phase":["NA"],"studyType":"INTERVENTIONAL","briefSummary":"The aim of this study will be to compare the approach of repeated applications of APDT versus surgical therapy for the treatment of residual pockets in generalized agressive periodontitis.","url":"https://clinicaltrials.gov/study/NCT03140059","countries":[],"locations":[],"sourceId":"clinical_trials","lastUpdate":"2017-10-18"},{"nctId":"NCT07403526","title":"Transforming Global Surgery Capacity and Capability Through Affordable Virtual Reality","status":"COMPLETED","phase":["NA"],"studyType":"INTERVENTIONAL","briefSummary":"The goal of this randomized controlled trial was to evaluate whether Deliberate Virtual Reality (VR) training can improve surgical skills, knowledge, and confidence in performing postpartum hysterectomy among junior-level Zambian physicians in training.\n\nThe main questions it aims to answer are:\n\n1. Can VR-based surgical training improve technical surgical skills in a real-world setting?\n2. Does Deliberate VR training enhance knowledge retention and confidence compared to standard clinical training?\n\nStudy Design: Researchers randomly assigned participants to either:\n\n1 Deliberate VR Training (intervention group): A 9-day VR-based surgical training program 2. Standard Training (control group): Conventional clinical education\n\nParticipants underwent assessments of surgical skills, knowledge, and confidence before and after training using objective structured assessment of technical skills (OSATS) and knowledge exams.\n\nKey Findings:\n\n1. The Deliberate VR group demonstrated significantly greater improvements in surgical knowledge, confidence, and OSATS scores compared to the standard training group.\n2. VR training showed strong skill transfer to real-world surgical performance, suggesting that affordable and scalable VR training can help bridge surgical workforce gaps in resource-constrained settings.\n\nThis study highlights VR-based training as a potential scalable solution to strengthen surgical capacity in maternal health, addressing workforce shortages and improving equitable access to essential surgical care.","url":"https://clinicaltrials.gov/study/NCT07403526","countries":["Zambia"],"locations":[{"facility":"University Teaching Hospital","city":"Lusaka","country":"Zambia"}],"sourceId":"clinical_trials","lastUpdate":"2026-02-11"},{"nctId":"NCT06562881","title":"Patient Navigation to Improve Surgical Access in Primary Hyperparathyroidism","status":"RECRUITING","phase":["NA"],"studyType":"INTERVENTIONAL","briefSummary":"The goal of this study is to address surgical health equity in historically marginalized participants with primary hyperparathyroidism (PHPT). The main questions that this study aims to answer are, how does patient navigation impact:\n\n* The proportion of PHPT participants undergo parathyroidectomy?\n* The proportion of PHPT participants who complete surgical consultation?\n* Time to surgical consultation?\n* Time to surgery?","url":"https://clinicaltrials.gov/study/NCT06562881","countries":["United States"],"locations":[{"facility":"Hospital of the University of Pennsylvania","city":"Philadelphia","country":"United States"}],"sourceId":"clinical_trials","lastUpdate":"2026-08-27"},{"nctId":"NCT05444218","title":"Surgical Access Combined With Systematically Administered Antibiotics in the Treatment of Peri-implantitis","status":"COMPLETED","phase":["NA"],"studyType":"INTERVENTIONAL","briefSummary":"This randomized clinical trial evaluates the clinical and microbiological (microbial complexes and changes in the diversity of the submucosal biofilm) effects of MTZ+AMX as adjuncts to anti-infectious surgical treatment plus Er: YAG in the treatment of peri-implantitis.","url":"https://clinicaltrials.gov/study/NCT05444218","countries":["Brazil"],"locations":[{"facility":"University of Guarulhos","city":"Guarulhos","country":"Brazil"}],"sourceId":"clinical_trials","lastUpdate":"2024-07-18"}]},"connectorProofs":[{"id":"demas_cnes","label":"CNES establishment schema","status":"success","schemaFields":["bairro_estabelecimento","codigo_atividade_ensino_unidade","codigo_cep_estabelecimento","codigo_cnes","codigo_esfera_administrativa_unidade","codigo_estabelecimento_saude","codigo_identificador_turno_atendimento","codigo_motivo_desabilitacao_estabelecimento","codigo_municipio","codigo_natureza_organizacao_unidade","codigo_nivel_hierarquia_unidade","codigo_tipo_unidade","codigo_uf","data_atualizacao","descricao_esfera_administrativa","descricao_natureza_juridica_estabelecimento","descricao_nivel_hierarquia","descricao_turno_atendimento","endereco_email_estabelecimento","endereco_estabelecimento","estabelecimento_faz_atendimento_ambulatorial_sus","estabelecimento_possui_atendimento_ambulatorial","estabelecimento_possui_atendimento_hospitalar","estabelecimento_possui_centro_cirurgico","estabelecimento_possui_centro_neonatal","estabelecimento_possui_centro_obstetrico","estabelecimento_possui_servico_apoio","latitude_estabelecimento_decimo_grau","longitude_estabelecimento_decimo_grau","natureza_organizacao_entidade","nome_fantasia","nome_razao_social","numero_cnpj","numero_cnpj_entidade","numero_estabelecimento","numero_telefone_estabelecimento","tipo_gestao"],"sampleRowsRetrieved":1,"sourceId":"demas_cnes","note":"Connectivity and schema proof only (example national registry). One response row does not establish data completeness, historical coverage, surgical relevance, or analytic validity."},{"id":"demas_sih","label":"SIH hospital-procedure schema","status":"success","schemaFields":["co_cnes","co_complexidade","co_financiamento","co_ibge","co_ibge_pac","co_proc_realizado","ds_complex_procedimento","ds_financiamento","ds_grupo_nat_jur","ds_natureza_juridica","ds_procedimento","no_fantasia","nu_ano","nu_cnpj","nu_comp","nu_valor_procedimento","qt_procedimento"],"sampleRowsRetrieved":1,"sourceId":"demas_sih","note":"Connectivity and schema proof only (example national registry). One response row does not establish data completeness, historical coverage, surgical relevance, or analytic validity."}],"limitations":["All World Bank economies are included; small states and territories often lack observations and remain visibly missing.","Latest values can refer to different years; the observation year is always shown next to the value.","Expenditure is shown in current US dollars and, separately, in PPP international dollars; neither is inflation-adjusted across years.","Missing values remain null; no interpolation, imputation or carry-forward in fixed-year mode.","Lancet Commission on Global Surgery indicators are compiled from heterogeneous national reports with irregular years and definitions.","National ecological indicators cannot estimate effects of a surgical intervention.","Bibliographic and registry retrieval is not a systematic evidence synthesis.","No patient-level records are included in this distributable snapshot."],"validation":{"countries":217,"indicators":12,"series":2604,"nonEmptySeries":2140,"observations":38141,"countriesWithAnyValue":{"physicians":195,"catastrophic":141,"spending":193,"sao":176,"cata10":158,"uhc":193,"population":217,"spending_ppp":193,"oop":193,"volume":123,"life":217,"impoverishing":141},"publications":17,"trials":5}}