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To the Editor We commend the timely article by Kotagal and Horvath1 that discusses the challenges of providing surgical care in under-resourced settings, and we look forward to more articles that address this important issue. As the authors point out, low- and middle-income countries have complex health systems with major discrepancies in quality of and access to care even within each country/region. In many low- and middle-income countries, private medical care contributes the lion’s share (80%) of the services provided, putting it out of the reach of millions.2 In a middle-income country like India, the overall physician to population ratio is 1:1800 (below 1:1000 established by the World Health Organization), while the situation in the rural areas of India is dire with only 25% of trained physicians available for 60% to 70% of the population. The Indian government reports that 70% of specialist (surgeons, pediatricians, and gynecologists) positions in rural government health centers are vacant. Proposals by governments to make rural service a mandatory component of medical education have been met with resistance by physicians and their associations. Surgeons and other specialists are reluctant to work in rural areas, pointing out a lack of infrastructure and opportunities for professional growth, among other reasons.
Nagarajan N, Varadaraj V. Helping Meet Surgical Needs in Under-resourced SettingsThe Role of Task Shifting. JAMA Surg. 2015;150(7):687-688. doi:10.1001/jamasurg.2015.0741