[Access to surgical, obstetrical and anaesthesia care in Mali: an assessment for a national plan]

The development of a national plan for surgery, obstetrics, and anaesthesia remains a priority for Mali. Our objective was to assess the availability, accessibility, quality, and financing of surgical, obstetric, and anaesthesia care, to provide the scientific basis for developing a national plan. This was a cross-sectional, prospective study conducted from January to June 2023. All regions of Mali, including the district of Bamako, were included. In each region, at least one health district was randomly selected. We selected 25 centres, representing 38% of public facilities. The survey involved district hospitals, health workers and patients. The data were analysed using R software version 4.5.1. Each hospital of the district covered a health area with a population ranging from 7,913 to 818,436. The time to reach the nearest public facility offering safe surgical care was 2 hours for 50% of the population. The total capacity of the facilities was 1,343 beds, or an average of 34 beds per 100,000 inhabitants. All 25 referral health centres had at least one operating room. The basic trio (general surgeon, obstetrician-gynaecologist, anesthesiologist-resuscitator) was available in 14 centres (56%). The average number of annual surgical procedures was 135 per 100,000 inhabitants. Caesarean section, hernia repair, appendectomy, and laparotomy were performed in all centres. Open bone injuries were treated in six centres. Costs for the same procedures varied from one centre to another, and health insurance coverage rates ranged from 1% to 25%. In Mali, surgery is inaccessible to the majority of the population. Limitations include geographic distance, the availability of well-equipped operating rooms and specialists, and low health insurance coverage rates.