How ready is the health care system in North East India for surgical delivery? A mixed methods study on surgical capacity and need

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Abstract
Background Surgical services are scarce with persisting inequalities in access across populations and regions globally. As the world’s most populous county, India’s surgical need is high and delivery rates estimated to be sub-par to meet need. There is a dearth of evidence particularly sub-regional data on surgical provisioning and need to aid planning. Aim and method This mixed methods study examines the state of surgical care in Northeast India, specifically health care system capacity and barriers to surgical delivery. It involved a facility based census and semi-structured interviews with surgeons and patients across four states in the region. Results Abdominal conditions constituted a large portion of the overall surgeries across public and private facilities in the region. Workloads varied among surgical providers across facilities. Task-shifting occurred, involving non-specialist nursing staff assisting doctors on surgical procedures or surgeons’ taking on anaesthetic tasks. Structural factors dis-incentivised facility level investment in suitable infrastructure. Patients’ care pathways were shaped by facility level shortages as well as personal preferences influenced by cost and distance to facilities. Discussion and conclusion skewed workloads across facilities and regions indicate uneven surgical delivery, with potentially variable care quality and provider efficiency. A systemic approach to referral coordination and human resource management are evident. Existing task shifting practices, along with incapacities induced by structural factors signal the direction of possible policy action.

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