Global surgery represents an emerging interdisciplinary field dedicated to enhancing health outcomes and promoting health equity by addressing the unmet need for surgical, obstetric and anaesthesia care, especially among underserved populations and those facing crises. This field focusses on improving access to equitable and comprehensive surgical care and strengthening healthcare delivery systems. The Lancet Commission on Global surgery of 2015 emphasises the importance of safe, timely, affordable and universal access to surgical care, highlighting the ease of reaching a surgical provider and receiving prompt and appropriate care as crucial components of timely access. Geospatial mapping and analysis are being used to assess access to surgical care in low- and middle-income countries and Africa. This data reveal disparities in access and is crucial for understanding health outcomes in different areas. Addressing geospatial determinants of health (GDOH) is essential for improving health equity, especially in these regions. Leveraging geospatial analysis can help mitigate delays in accessing care and improve resource allocation to strengthen healthcare systems. We propose that the interrogation of GDOH is critical in advancing surgical health, averting disease and implementing surgical interventions and programmes.
Global surgery is a relatively new and emerging interdisciplinary field of enquiry, research, practice and advocacy. It aims to improve health outcomes and achieve health equity for all people who need surgical, obstetric and anaesthesia care, with a special emphasis on underserved, marginalised populations and those in crisis.
As an emerging discipline and science, global surgery interrogates the unmet need for access to care and the quality of surgical care, focussing on strengthening the health system.
The Lancet Commission on Global Surgery of 2015 underscores safe, timely, affordable and universal access to surgical care. Two cardinal components of timely access include the ease of reaching a surgical provider and the provision of prompt and/or appropriate care from the provider.
Geospatial mapping and/or analysis (a visualisation methodology) has been used in low- and middle-income countries (LMICs) and Africa in various ways.
In Somaliland, approximately 16.9% of the population live within a 2-h driving distance of a surgeon; in Uganda, Rwanda and Liberia, patients travel 30 km to see a surgeon, and in Ethiopia the patients travel 144 km.
Africa is broad and diverse. The determinants of access to health and well-being vary widely by place and time, and the inclusive term for this variance is geospatial determinants of health (GDOH). Geospatial determinants of health includes ‘eco-anxiety’, which is the chronic fear of environmental factors that are currently being experienced and will likely impact a community’s healthcare, access and provision.
In Africa, 1 billion people lack access to safe and timely surgery. The GDOH and its methodology may offer a key to reducing the unmet need for surgical services in LMICs.
The majority of the settings in Africa have fragile and poor infrastructure, deficient health systems underscored by ineffective equipment, and a scarcity of supplies including drugs, anaesthesia and oxygen, which is further compounded by poor and/or barely existent referral systems leading to ineptitude in tracking routine procedures both in theatre and pre- and post-theatre.
The GDOH encompass a wide range of geographic and spatial factors that significantly influence human health and well-being.
We cannot afford to overlook the importance of understanding the GDOH and global surgery. This understanding is crucial in identifying and comprehending the relationship between these determinants and health outcomes. It will guide us in targeting interventions and policy decisions to improve health equity outcomes, especially in LMICs and Africa, and prompt us to take immediate action.
Geospatial determinants of health concepts, including spatial analysis, will equip global surgery experts and public health scientists in Africa and LMICs to examine, characterise and analyse the vital relationship between healthcare facility location and healthcare access and outcomes. Donabedian’s triad (structure, process and outcomes) in the quality-improvement literature highlights that variance of healthcare quality and access only accounts for 20% of health outcomes; what accounts for everything else is what we call the social and GDOHs.
What is the geographical access on the African continent, and what services are available in Africa?
What is the disease burden and outcomes in the diverse African geographical area?
What interventions can be implemented to strengthen the health systems in the diverse geographical area of Africa?
Geospatial determinants of health methodology, as an integral part of delivering health, should not be confined to academic circles. It should be actively integrated into public institutions. This integration is not just a recommendation, but a call to action for the global surgery community to take up the responsibility of advocating for the use of geospatial determinants in public health. In the African context, GDOH can be helpful in:
Beyond LMICs and Africa, geospatial analysis science can help to facilitate and reduce barriers associated with geographical accessibility to surgical care. Understanding the geographical barriers to accessing care within specific time frames allows scientists, stakeholders, investors and governments to use evidence-based methods to improve the delivery of surgical services for vulnerable and underserved populations. Geospatial analysis and GDOH primarily addresses the delay in ‘reaching’ the health facility and, to a certain extent, the delay in ‘receiving’ appropriate care.
The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.
M.I. conceptualised the study and contributed to investigation, data curation, methodology, data analysis, original draft preparation and write up, formal analysis and software validation. Y.Z. was involved in writing review, investigation, formal analysis, data curation, revising the original draft critically for important intellectual content and approved the version to be published. S.M. contributed to conceptualisation, review and editing, resource allocation in form of funds, transport, final draft preparation and writing original draft.
Data sharing is not applicable to this article as no new data were created or analysed in this study.
The views and opinions expressed in this article are those of the authors and are the product of professional research. The article does not necessarily reflect the official policy or position of any affiliated institution, funder, agency or that of the publisher. The authors are responsible for this article’s results, findings and content.