challenges relate to freezes on or a decline in public
sector spending. Maureen Lewis, PhD, an economist
and chief executive officer of Aceso Global, a not-for-profit organization committed to improving health
care delivery and management in emerging markets,
spoke on the need to prioritize effective management,
efficiency, and quality reforms in order to do more, and
to do better with less (see photos, this page).
Dr. Lewis noted that quality and efficiency extend
well beyond the walls of the operating room and highlighted the need to address the continuum of surgical
patient care from initial presentation to follow-up.
Symposium participants concluded that three pillars
should underpin efficiency efforts: strong management, appropriate incentives, and robust data.
The issue of strong management was of particular
importance, and some delegates were concerned that
management professionals in Latin America’s complex health care domain are under-trained for the role
The second pillar requires a restructuring of appropriate incentives for quality measures at both the
facility and staff level. As an example of misaligned
incentives, participants spoke of public systems
throughout the region in which providers receive
below-cost reimbursements. As a result, if the hospital takes on more volume it actually loses money
because the per procedure reimbursement is less than
the per procedure cost.
The third pillar, data, was referenced repeatedly
throughout the day as a major barrier to efficient and
effective surgical practice. Although health care data are
regularly collected in Latin America—even digitally,
in some cases—the quality and management of these
data varies and they are rarely leveraged for system-level decision making. As a result, participants called for
the establishment of a basic, consensus-driven, streamlined set of minimum data requirements. All delegates
agreed that the most important part of collecting data
is leveraging it to guide management decisions.
Surgical workforce maldistribution
Another broad challenge for global surgery is how the
surgical, anesthesia, and obstetrics (SAO) workforce
can adequately meet the demands of underserved populations. Mário Scheffer, PhD, from the Departamento
de Medicina Preventiva, Universidade de São Paulo,
Brazil, and a co-author of this article, highlighted the
maldistribution of health care professionals in Brazil.
Although the national average of SAO specialists meets
the LCoGS’ target of 20 to 40 SAO professionals per
100,000 patients, there are marked disparities between
the well-served south and the underserved north and
northeast areas of Brazil (see Figure 2, page 25).
Referring to 2014 data, Dr. Scheffer noted that most
Brazilian physicians work in the private sector (78.4
percent, with 26. 9 percent working exclusively in the
OPERATING THEATERS IN REMOTE AREAS
OF THE STATE OF AMAZONAS
Functional but aging infrastructure exists even in remote areas of Brazil. The present
concern is with workforce, upkeep, and ongoing operational expenditure.