[Skip to Content]
[Skip to Content Landing]
Original Investigation
November 2016

Mapping Disparities in Access to Safe, Timely, and Essential Surgical Care in Zambia

Author Affiliations
  • 1Division of General Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California
  • 2Permanent Mission of Zambia, Geneva, Switzerland
  • 3Zambian Ministry of Health, Lusaka, Zambia
  • 4Division of Pediatric General and Thoracic Surgery, Department of Surgery, Children’s Hospital of Wisconsin, Milwaukee
JAMA Surg. 2016;151(11):1064-1069. doi:10.1001/jamasurg.2016.2303
Key Points

Question  What proportion of Zambia’s population has access to timely, safe, and essential surgical care?

Findings  This observational study of 103 surgical facilities in Zambia found that 14.9% of the population did not live within 2 hours from a surgical facility. However, when access to safe surgical facilities and access to facilities providing essential surgical care was assessed, 65.9% and 80.7%, respectively, did not live within 2 hours from such surgical facilities.

Meaning  Large disparities in access to safe, essential, and timely surgical care exist in Zambia; this study provides insight into improved allocation of resources.


Importance  Surgical care is widely unavailable in developing countries; advocates recommend that countries evaluate and report on access to surgical care to improve availability and aid health planners in decision making.

Objective  To analyze the infrastructure, capacity, and availability of surgical care in Zambia to inform health policy priorities.

Design, Setting, and Participants  In this observational study, all hospitals providing surgical care were identified in cooperation with the Zambian Ministry of Health. On-site data collection was conducted from February 1 through August 30, 2011, with an adapted World Health Organization Global Initiative for Emergency and Essential Surgical Care survey. Data collection at each facility included interviews with hospital personnel and assessment of material resources. Data were geocoded and analyzed in a data visualization platform from March 1 to December 1, 2015. We analyzed time and distance to surgical services, as well as the proportion of the population living within 2 hours from a facility providing surgical care.

Main Outcomes and Measures  Surgical capacity, supplies, human resources, and infrastructure at each surgical facility, as well as the population living within 2 hours from a hospital providing surgical care.

Results  Data were collected from all 103 surgical facilities identified as providing surgical care. When including all surgical facilities (regardless of human resources and supplies), 14.9% of the population (2 166 460 of 14 500 000 people) lived more than 2 hours from surgical care. However, only 17 hospitals (16.5%) met the World Health Organization minimum standards of surgical safety; when limiting the analysis to these hospitals, 65.9% of the population (9 552 780 people) lived in an area that was more than 2 hours from a surgical facility. Geographic analysis of emergency and essential surgical care, defined as access to trauma care, obstetric care, and care of common abdominal emergencies, found that 80.7% of the population (11 704 700 people) lived in an area that was more than 2 hours from these surgical facilities.

Conclusions and Relevance  A large proportion of the population in Zambia does not have access to safe and timely surgical care; this percentage would change substantially if all surgical hospitals were adequately resourced. Geospatial visualization tools assist in the evaluation of surgical infrastructure in Zambia and can identify key areas for improvement.