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Sustainable Development in Surgery: The Health, Poverty, and Equity Impacts of Charitable Surgery in Uganda

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  • Mark G Shrime
  • Serufusa Sekidde
  • Allison Linden
  • Jessica L Cohen
  • Milton C Weinstein
  • Joshua A Salomon

Abstract

Background: The recently adopted Sustainable Development Goals call for the end of poverty and the equitable provision of healthcare. These goals are often at odds, however: health seeking can lead to catastrophic spending, an outcome for which cancer patients and the poor in resource-limited settings are at particularly high risk. How various health policies affect the additional aims of financial wellbeing and equity is poorly understood. This paper evaluates the health, financial, and equity impacts of governmental and charitable policies for surgical oncology in a resource-limited setting. Methods: Three charitable platforms for surgical oncology delivery in Uganda were compared to six governmental policies aimed at improving healthcare access. An extended cost-effectiveness analysis using an agent-based simulation model examined the numbers of lives saved, catastrophic expenditure averted, impoverishment averted, costs, and the distribution of benefits across the wealth spectrum. Findings: Of the nine policies and platforms evaluated, two were able to provide simultaneous health and financial benefits efficiently and equitably: mobile surgical units and governmental policies that simultaneously address surgical scaleup, the cost of surgery, and the cost of transportation. Policies that only remove user fees are dominated, as is the commonly employed short-term “surgical mission trip”. These results are robust to scenario and sensitivity analyses. Interpretation: The most common platforms for increasing access to surgical care appear unable to provide health and financial risk protection equitably. On the other hand, mobile surgical units, to date an underutilized delivery platform, are able to deliver surgical oncology in a manner that meets sustainable development goals by improving health, financial solvency, and equity. These platforms compare favorably with policies that holistically address surgical delivery and should be considered as countries strengthen health systems.

Suggested Citation

  • Mark G Shrime & Serufusa Sekidde & Allison Linden & Jessica L Cohen & Milton C Weinstein & Joshua A Salomon, 2016. "Sustainable Development in Surgery: The Health, Poverty, and Equity Impacts of Charitable Surgery in Uganda," PLOS ONE, Public Library of Science, vol. 11(12), pages 1-14, December.
    • Handle: RePEc:plo:pone00:0168867
    DOI: 10.1371/journal.pone.0168867
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    References listed on IDEAS

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    1. Hannah Kuper & Sarah Polack & Wanjiku Mathenge & Cristina Eusebio & Zakia Wadud & Mamunur Rashid & Allen Foster, 2010. "Does Cataract Surgery Alleviate Poverty? Evidence from a Multi-Centre Intervention Study Conducted in Kenya, the Philippines and Bangladesh," PLOS ONE, Public Library of Science, vol. 5(11), pages 1-10, November.
    2. Salem, A B Z & Mount, T D, 1974. "A Convenient Descriptive Model of Income Distribution: The Gamma Density," Econometrica, Econometric Society, vol. 42(6), pages 1115-1127, November.
    3. Xu, Ke & Evans, David B. & Kadama, Patrick & Nabyonga, Juliet & Ogwal, Peter Ogwang & Nabukhonzo, Pamela & Aguilar, Ana Mylena, 2006. "Understanding the impact of eliminating user fees: Utilization and catastrophic health expenditures in Uganda," Social Science & Medicine, Elsevier, vol. 62(4), pages 866-876, February.
    4. Charnes, A. & Cooper, W. W. & Rhodes, E., 1978. "Measuring the efficiency of decision making units," European Journal of Operational Research, Elsevier, vol. 2(6), pages 429-444, November.
    5. Thaddeus, Sereen & Maine, Deborah, 1994. "Too far to walk: Maternal mortality in context," Social Science & Medicine, Elsevier, vol. 38(8), pages 1091-1110, April.
    6. Menno Pradhan & Nicholas Prescott, 2002. "Social risk management options for medical care in Indonesia," Health Economics, John Wiley & Sons, Ltd., vol. 11(5), pages 431-446, July.
    7. Daniel G. Brown & Rick Riolo & Derek T. Robinson & Michael North & William Rand, 2005. "Spatial process and data models: Toward integration of agent-based models and GIS," Journal of Geographical Systems, Springer, vol. 7(1), pages 25-47, October.
    8. A. Charnes & W. W. Cooper & E. Rhodes, 1981. "Evaluating Program and Managerial Efficiency: An Application of Data Envelopment Analysis to Program Follow Through," Management Science, INFORMS, vol. 27(6), pages 668-697, June.
    9. World Bank, 2014. "World Development Indicators 2014," World Bank Publications - Books, The World Bank Group, number 18237.
    10. Hotchkiss, David R., 1998. "The tradeoff between price and quality of services in the Philippines," Social Science & Medicine, Elsevier, vol. 46(2), pages 227-242, January.
    11. World Bank, 2013. "World Development Indicators 2013," World Bank Publications - Books, The World Bank Group, number 13191.
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    Cited by:

    1. Christopher Strader & Joanna Ashby & Dominique Vervoort & Aref Ebrahimi & Shoghi Agbortoko & Melissa Lee & Naomi Reiner & Molly Zeme & Mark G Shrime, 2020. "How much is enough? Exploring the dose-response relationship between cash transfers and surgical utilization in a resource-poor setting," PLOS ONE, Public Library of Science, vol. 15(5), pages 1-12, May.

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