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August 2018

True Demand for Data

Michael M. Lokshin's picture
Headquarters of the United Nations
Photo: Yutaka Nagata (CC BY 2.0)

A snow storm was barreling toward New York City and the roster of attendees at the UN Statistical Committee meeting—myself included—fully expected that all flights would be canceled. Fifty statisticians made the same calculation—to find the closest bar. I headed to the Vienna Café in the UN headquarters building, a place which affords one the rarified opportunity to socialize with high-level government officials from around the world. On my way in, I recognized the Director-General of a statistics office from an African country and we spoke. I mentioned several statistical programs that donors were planning to finance in his country. He expressed enthusiasm about these projects but voiced an increasingly familiar note of concern about long term sustainability of his agency in general. He fretted that his entire statistical office would collapse without donor support. He admitted that most of the demand for data was coming from the donors themselves, as indicators for their own reporting and planning; the country’s own government had much less interest in data or statistics.

Celebrating 50 years of measuring world economies

Edie Purdie's picture

The ICP blog series explores ideas and issues under the International Comparison Program umbrella – including innovations in price and data collection, discussions on purpose and methodology, as well the use of purchasing power parities in the growing world of development data. Authors from across the globe, whether ICP practitioners or researchers making use of ICP data, are encouraged to submit relevant blogs for consideration to [email protected].

A visitor to the World Bank’s atrium on May 23, 2018 would have seen a who’s who of eminent economists and statisticians congregating to celebrate the 50th anniversary of the International Comparison Program. Organized by the Global ICP Unit based in the World Bank in Washington, D.C, a large local, and virtual, audience gathered to hear the thoughts and reflections of major ICP players at the “50 Years of Measuring World Economies” event.

Cured Into Destitution: the risk of financial catastrophe after surgery

Kathryn Wall's picture
Also available in: العربية | Español

Low-income countries face the highest risk of financial catastrophe due to surgery and have made the slowest progress

Five billion people—two thirds of the world’s population—lack access to safe, timely, and affordable surgical, anesthesia, and obstetric (SAO) care, as World Bank Group President Dr. Jim Yong Kim stated. Of the myriad barriers to accessing SAO care—safety, for example, or the lack of a well-trained workforce—one of the largest is financial. For patients, surgery can be very expensive. Not only can the financial burden of seeking surgical care be a formidable obstacle to those who need surgery, it can also have a devastating impact on those who are able to receive it. Over two billion people cannot afford surgery if they needed it today, and, of those who get surgery every year, an estimated 33 million of them will undergo financial hardship from its direct costs—81 million when the ancillary costs of care like transportation and food are included.

Why are people dying following surgery in Africa?

Bruce Biccard's picture

Surgery is a core component of health. It is a cost-effective intervention1 which is important for global health.2 However, to fully realize the health benefits of surgery, it needs to be safe. In the African continent—with a population of 1.2 billion people—it is estimated that approximately 95% do not have access to safe and affordable surgery. The Lancet Commission on Global Surgery has established six indicators to indicate the success of providing access to safe and affordable surgery.3 Four of them are included in the World Bank’s World Development Indicators (WDI) database. The perioperative mortality rate (POMR)—the number of in-hospital deaths from any cause in patients who have undergone a procedure done in an operating theatre, divided by the total number of procedures—is one of the indicators the success in achieving safe surgery, yet it is not included in the WDI as the data is sparse, including the one from Africa. The recent publication of the African Surgical Outcomes Study (ASOS) has cast an important light on the POMR in Africa.4

ASOS has shown that for patients in Africa fortunate enough to access surgical care, the patient outcomes following surgery are relatively poor. ASOS demonstrated that African surgical patients were twice as likely to die following surgery when compared to the global average, despite a similar complication rate to the global average (Table 1). This is despite the fact that surgical patients in Africa are relatively healthy when compared with similar international surgical patient cohorts,5 and one would thus expect them to do well postoperatively. Therefore, if the data from ASOS had been risk-adjusted for patient comorbidities, it is likely that the mortality following surgery in Africa is more than twice the global average. The results from ASOS are compelling as they provide comprehensive data on surgical outcomes in Africa, from 25 countries, 247 hospitals, and over 11,000 patients.

Table 1. Mortality, complications and ‘failure to rescue’ following surgery

Source: ISOS International Surgical Outcomes Study ASOS African Surgical Outcomes Study4
  ISOS
(elective surgery)
ASOS
(elective surgery)
ASOS
(elective and emergency surgery)
Mortality 207/44 814 (0.5%) 48/4792 (1.0%) 239/11193 (2.1%)
Complications 7508/44814 (16.8%) 624/4658 (13.4%) 1977/10885 (18.2%)
Death following complication
(failure to rescue)
207/7508 (2.8%) 30/620 (4.8%) 188/1970 (9.5%)