After the procedure, however, the patient returns for post-surgical care and is followed through the recovery period at the central hospital itself. The surgery department here ‘outsources’ some specialized surgeries (neurosurgery, vascular surgery and complex surgical oncology) to tertiary care hospitals by issuing cashless vouchers to the patients. This central hospital is situated within the residential complex meant for the employees. Referral linkages exist between these primary facilities and the central hospital, where patients are provided secondary as well as select tertiary care services like urology and basic surgical oncology. The health scheme is implemented through pyramid of healthcare services consisting of 14 primary healthcare facilities, spread across the city and suburbs of Mumbai, and a central referral hospital. independent of economic status and individual health risks due to pre-existing illnesses. It delivers health coverage equitably, i.e. This scheme is implemented for employees and their families of Department of Atomic Energy (DAE, Govt of India) and provides healthcare services at a minimum flat contribution of one percent of the basic pay of the employee. We carried out this study in a cohort covered under, ‘Contributory Health Service Scheme’ (CHSS). The study also aims to test whether the LCoGS benchmark estimate of 5000 surgeries per 100,000 population is valid in an Indian urban population. It provides three main components: first, a single electronic medical records system for enumeration and documentation of surgical procedures and second, a Universal Health Coverage (UHC) system where surgeries can be performed when needed and thirdly, a setting where the number of surgeries performed are not incentivized. Our cohort provides a near ideal setting to assess the burden of surgical diseases. This study aims to assess the surgical needs in an urban cohort of 88,273 people who are covered under an Universal Health Coverage (UHC) scheme in Mumbai, India. Population-based studies which enumerate the actual number of surgeries performed in the LMIC context are needed. Surgical needs in LMIC have been described, mainly by using estimates and mathematical modelling. Addressing and enumerating surgical needs of the population, especially in low-middle-income countries (LMIC), was emphasized by the second edition of Disease Control Priorities (DCP) and was refined further by the DCP 3. This variation is explained by unavailability of surgeons, anaesthetists, obstetricians (SAOs), lack of access to healthcare facilities and underreporting of the surgeries that are performed. The reported rates of surgery vary from 295 in LMICs to 23,000 in high-income countries (HIC) per 100,000 population. The Lancet Commission for Global Surgery (LCoGS) estimated 5000 surgeries are required to meet the surgical burden of diseases of 100,000 people in low- and middle-income countries (LMICs). More enumeration-based studies are needed for better estimates from rural as well as other urban areas.ġ1% of the global burden of disease requires surgical or anaesthesia care or both. Caesarean section, cataract, surgeries for fractures and hernia are the major contributors to the surgical needs. ConclusionĪ total of 3646 surgeries were estimated annually to meet the surgical needs of Indian population as compared to the global estimate of 5000 surgeries per 100,000 people. One-third of these surgeries would be needed for the age group 30–49 years, in the Indian population. We estimated 3646 surgeries would be required per 100,000 Indian population per year. 44.2% of surgeries belonged to the essential surgeries. Cataract (22.8%), Caesareans (3.8%), surgeries for fractures (3.27%) and hernia (2.86%) were the commonest surgeries. ResultĪ total of 4642 surgeries were performed per year for a population of 88,273. We estimated the surgical needs for national population, based on age and sex distribution of surgeries and age standardization from our cohort. Surgical procedures performed in 20, under this free and equitable health scheme, were enumerated. We performed this study in an urban population availing employees’ heath scheme in Mumbai, India. Studies from LMICs, estimating surgical burden based on enumeration of surgeries, are sparse. The Lancet Commission for Global Surgery (LCoGS) estimated that 5000 surgeries are required to meet the surgical burden of disease for 100,000 people in LMICs. Some studies have estimated this burden to be as high as 30%. 11% of the global burden of disease requires surgical care or anaesthesia management or both.
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