The Geography of Unequal Access to Surgical and Anaesthesiology in Nigeria

Sabrina Juran, United Nations Population Fund (UNFPA)
Mohamed Abd salam EL Vilaly, United Nations Population Fund (UNFPA
Tatem Andy, WorldPp/Flowminder
Emmanuel Ameh, Department of Surgery National Hospital, Abuja
John Meara, Harvard Medical School
Tapiwa Jhamba, United Nations Population Fund (UNFPA)

Major district and regional hospitals were assumed to have capability to perform bellwether procedures. Geographical locations of hospitals in relation to the population in the 47 sub-Saharan countries were combined with spatial ancillary data on roads, elevation, land use or land cover to estimate travel-time metrics of 30 min, 1 hour and 2 hours. Hospital catchment was defined as population residing in areas less than 2 hours of travel time to the next major hospital. Travel-time metrics were combined with fine-scale population maps to define burden of surgery at hospital catchment level. Overall, the majority of the population (92.5%) in sub-Saharan Africa reside in areas within 2 hours of a major hospital catchment defined based on spatially defined travel times. The burden of surgery in all-age population was 257.8 million to 294.7 million people and was highest in high-population density countries and lowest in sparsely populated or smaller countries.