Access to surgery in Ecuador using the enhanced 2-step floating catchment area approach

Area of Science:

• Global Surgery
• Health Services Research
• Geospatial Analysis

Background:

• Traditional surgical access metrics lack local policy relevance.
• The Enhanced Two-Step Floating Catchment Area (E2SFCA) method offers granular access estimates and incorporates surgical supply.
• E2SFCA application in Ecuador provides a novel approach to assessing surgical access.

Purpose of the Study:

• To calculate surgical access in Ecuador using the E2SFCA method.
• To compare E2SFCA with traditional global surgery indicators.
• To identify granular disparities in surgical access and supply.

Main Methods:

• Collected surgical supply data (providers, surgeries) from Ecuadorian governmental hospitals (2022).
• Calculated traditional indicators (surgical density, volume, 2-hour access).
• Applied E2SFCA analysis at 1km x 1km resolution, defining adequate access based on Lancet Commission thresholds.

Main Results:

• Ecuador has 89.7% 2-hour geospatial access, 23.7 providers/100,000, and 2,473 surgeries/100,000.
• Only 1.2% of the population has adequate access to all three indicators (provider, volume, access), limited by surgical volume.
• Significant geospatial variation in access exists; one additional SAO provider correlates with 104.6 procedures.

Conclusions:

• E2SFCA method provides granular surgical access evaluation without complex data collection.
• The method incorporates procedure supply and provider availability for detailed insights.
• Granular access evaluation enables targeted interventions to improve surgical access for policymakers.