• Joseph D Forrester, Jared A Forrester, Thaim B Kamara, Reinou S Groen, Sunil Shrestha, Shailvi Gupta, Patrick Kyamanywa, Robin T Petroze, Adam L Kushner, and Sherry M Wren.
• Department of Surgery, Stanford University, Stanford, California.
• JAMA Surg. 2016 Mar 1; 151 (3): 257-63.

ImportanceSurgical care is recognized as a growing component of global public health.ObjectiveTo assess self-reported barriers to access of surgical care in Sierra Leone, Rwanda, and Nepal using the validated Surgeons OverSeas Assessment of Surgical Need tool.Design, Setting, And ParticipantsData for this cross-sectional, cluster-based population survey were collected from households in Rwanda (October 2011), Sierra Leone (January 2012), and Nepal (May and June 2014) using the Surgeons OverSeas Assessment of Surgical Need tool.Main Outcomes And MeasuresBasic demographic information, cost and mode of transportation to health care facilities, and barriers to access to surgical care of persons dying within the past year were analyzed.ResultsA total of 4822 households were surveyed in Nepal, Rwanda, and Sierra Leone. Primary health care facilities were commonly reached rapidly by foot (>70%), transportation to secondary facilities differed by country, and public transportation was ubiquitously required for access to a tertiary care facility (46%-82% of respondents). Reasons for not seeking surgical care when needed included no money for health care (Sierra Leone: n = 103; 55%), a person dying before health care could be arranged (all countries: 32%-43%), no health care facility available (Nepal: n = 11; 42%), and a lack of trust in health care (Rwanda: n = 6; 26%).Conclusions And RelevanceSelf-reported determinants of access to surgical care vary widely among Sierra Leone, Rwanda, and Nepal, although commonalities exist. Understanding the epidemiology of barriers to surgical care is essential to effectively provide surgical service as a public health commodity in developing countries.

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