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Every country has some sort of system to provide surgical and other health services at various levels, with a progressive increase in the capacity to treat more complicated problems.

Greetings. I am a cancer specialist, a Medical Oncologist. After training at the prestigious Army Hospital R&R in Delhi, I had the opportunity to work with illustrious and famous faculty at two of my previous tenures. I now work with a team of expert cancer specialists at BGS GLOBAL Hospitals Bangalore.

After training at the prestigious Army Hospital R&R in Delhi, I had the opportunity to work with illustrious and famous faculty at two of my previous tenures. I now work with a team of expert cancer specialists at BGS GLOBAL Hospitals Bangalore.

 
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• 1914 translation by H. Rackham
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• Contrary to popular belief

The Ideal

While most health systems are organized as a pyramid, with primary care facilities at the base and national third-level hospitals at the apex, the specifics vary among countries (Chatterjee, Levin, and Laxminarayan 2013); (Galukande and others 2010); (Lebrun and others 2013); (Zafar and McQueen 2011). In most of Sub-Saharan Africa, dispensaries and health centers provide primary care, deliver newborns, and usually perform minor surgery. When patients need major surgery, they are meant to be referred to a district (first-level) hospital with 100 to 200 beds, serving a population of 100,000 to 500,000 (Galukande and others 2010). In Bangladesh, India, and Pakistan, the smallest unit regularly providing major surgery is also called a district hospital, but the districts are much bigger, usually with a population of 2 million or more (Chatterjee, Levin, and Laxminarayan 2013); (Lebrun and others 2013); (Zafar and McQueen 2011). In Latin America and the Caribbean, many quite small "basic hospitals" provide first-level surgical functions for populations of fewer than 100,000 and refer patients to a fairly extensive network of second- and third-level hospitals (Lebrun and others 2012); (Solis and others 2013).

However, regardless of how the pyramid is structured, the constraints listed previously significantly limit its functionality. The two most important and challenging constraints include the shortage of trained staff, which limits the services that can be provided, especially in first-level hospitals, and the weakness of the referral system, which often hinders sending patients to a higher level where more highly trained staff may be available. Clearly, these two problems work against each other. If trained staff are unavailable, patients should be referred. If they cannot be referred, they often do not receive appropriate treatment, potentially leading to death or serious disability. While the emphasis today should be on initiatives to increase the capacity of peripheral first-level hospitals, access to transportation and referrals can reduce the need for this expansion of capacity and lead to a more efficient system.