A Household Survey to Evaluate Access to Surgical Care in Vanuatu
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SURGERY IN LOW AND MIDDLE INCOME COUNTRIES
A Household Survey to Evaluate Access to Surgical Care in Vanuatu N. Bunkley1
•
I. Bissett1 • M. Buka2 • J. Bong2 • B. Leodoro2 • A. Dare3 • W. Perry1
Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Introduction Surgical care is an integral part of any healthcare system, yet there is a paucity of data on the burden of surgical disease, surgical capacity and access to surgical services in the Pacific region. This study aimed to evaluate access to surgical care through a pilot household survey in the Vanuatu island of Efate and five of its surrounding islands. Methods The 2009 Vanuatu census’ GPS coordinates were used to randomly select 150 rural and 150 urban households from Efate and its surrounding islands. A total of 143 urban households and 142 rural households were available for inclusion in this study. A household questionnaire was developed to evaluate access to surgical care and included information regarding household demographics, socio-economic indicators and perceived and realised barriers to accessing care. The questionnaire was administered by local health workers, and data were collected electronically. Results Questionnaires were completed by 285 households. Two hundred and forty-one out of 254 (94.8%) households reported being able to access Port Vila Hospital, if required. The most commonly cited potential barriers to accessing surgical care were financial constraints (42.4%) and transport (26.4%). Conclusion Our results provide important insights into the geographic, sociocultural and economic barriers to seeking, reaching and receiving surgical care in this region of Vanuatu. Identifying specific areas and communities with poor access to care, alongside the determinants of access, will help in designing both clinical and policy interventions to improve access to surgical care.
Introduction
& N. Bunkley [email protected] 1
Global Surgery Group, Department of Surgery, Faculty of Medical and Health Sciences, Surgical and Translational Research Centre, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
2
Northern Provincial Hospital, Luganville, Sanma Province, Vanuatu
3
Department of Surgery, University of Toronto, 27 King’s College Circle, Toronto, ON M5S 1A1, Canada
Vanuatu is an archipelago of 83 separate islands in the southwest of the Western Pacific region. It is ranked 141st among 189 countries on the United Nations Development Program (UNDP) Human Development Index [1] and has a population of about 270,000 with 75% living in rural areas [2]. The country has a severe health workforce crisis with a physician density of 0.2 physicians per 1000 population [3, 4]. Surgical care requiring general anaesthesia is delivered at two hospitals: Villa Central Hospital (VCH) in Efate and Northern District Hospital in Espirito Santo, meaning a large proportion of the population must travel by
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boat to reach the nearest government-provided health facility. A recent facility-based study conducted in Vanu
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