A geospatial analysis of two-hour surgical access to district hospitals in South Africa

• Main Authors: Kathryn M. Chu, Angela J. Dell, Harry Moultrie, Candy Day, Megan Naidoo, Stephanie van Straten, Sarah Rayne
• Format: Article
• Language: English
• Published: BMC 2020-08-01
• Series: BMC Health Services Research
• Subjects: Global surgery; Surgical access; Geographic information systems; Surgical capacity; District hospital; South Africa
• Online Access: http://link.springer.com/article/10.1186/s12913-020-05637-0

Abstract Background In a robust health care system, at least 80% of a country’s population should be able to access a district hospital that provides surgical care within 2 hours. The objective was to identify the proportion of the population living within 2 hours of a district hospital with surgical capacity in South Africa. Methods All government hospitals in the country were identified. Surgical district hospitals were defined as district hospitals with a surgical provider, a functional operating theatre, and the provision of at least one caesarean section annually. The proportion of the population within two-hour access was estimated using service area methods. Results Ninety-eight percent of the population had two-hour access to any government hospital in South Africa. One hundred and thirty-eight of 240 (58%) district hospitals had surgical capacity and 86% of the population had two-hour access to these facilities. Conclusion Improving equitable surgical access is urgently needed in sub-Saharan Africa. This study demonstrated that in South Africa, just over half of district hospitals had surgical capacity but more than 80% of the population had two-hour access to these facilities. Strengthening district hospital surgical capacity is an international mandate and needed to improve access.