MGHD 2024

Background: Surgical conditions contribute to one third of the global burden of disease. To understand the state of surgical services in Central Equatoria State (CES) in particular, and South Sudan at large, we conducted a baseline assessment and mapped out access to surgical services. Objectives: The objectives of this study were to identify healthcare facilities in CES, South Sudan capable of providing essential surgical services using Bellwether procedures as a proxy measure; characterize the geographical distribution of these facilities; and map out proportion of the population with 2-hour geographical access to surgery-capable facilities using geospatial mapping tools. Methods: We conducted a facility-based, cross sectional walk-through study with quantitative and spatial analysis methods at six key public health facilities in CES, South Sudan. A validated Program in Global Surgery and Social Change Surgical Assessment Tool (PGSSC SAT) was used to collect data on service delivery, infrastructure, workforce, information management and financing. Data was summarized descriptively using percentages, mean (standard deviation), median (interquartile range) as well as visually in maps, graphs, charts, and tables. Geospatial data was collected and analyzed using ArcGIS. We integrated various spatial datasets, including road networks, travel speeds, and geographic barriers to determine and visualize the proportion of the population with 2-hour geographical access to surgical care. Results: Our study showed that only 50% of the health facilities had the capacity to provide Bellwether procedures to their catchment population. Workforce availability and surgical infrastructure were some of the major constraints on the delivery of surgical care in Central Equatoria State. We also found limited geographical coverage at some of the assessed health facilities. The 2-hour geographical was only 77.3% with better coverage around Juba Teaching Hospital than at the county hospitals located peripherally. Conclusion: Our findings showed lack of capacity to offer Bellwether procedures at half of the health facilities, limited geographical distribution and poor 2-hour access to surgery-capable facilities. We recommend that the national ministry of health with its state counterparts take bold steps to improve access to surgical services. This should start with developing a national surgical policy and strategic plan, which will ultimately improve surgical infrastructure, surgical workforce, financing and other pillars of surgical and anesthesia care in South Sudan. Key words: Surgical care, geographical access, surgical policy, Bellwether procedures