Person: Raykar, Nakul
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Raykar
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Nakul
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Raykar, Nakul
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Publication Access to safe blood in low-income and middle-income countries: lessons from India(BMJ, 2017) Jenny, Hillary; Saluja, Saurabh; Sood, Rachita; Raykar, Nakul; Kataria, Raman; Tongaonkar, Ravindranath; Roy, NobhojitTimely, affordable access to screened blood is essential to the provision of safe surgical care, and depends on three key aspects: adequate volume of blood supply, safe protocols for blood donation and transfusion, and appropriate regulation to ensure safe, equitable, and sustainable distribution. Many low- and middle-income countries experience a deficit in these categories, particularly in rural areas. We draw on the experience of rural surgical practitioners in India and summarize the existing literature to evaluate India’s blood banking system and discuss its major barriers to the safe and equitable provision of blood. Many low- and middle-income countries struggle with accruing a sufficient voluntary, unpaid blood donation base to meet the need. Efforts to increase blood supply through mandatory family replacement donations can lead to dangerous delays in care provision. Additionally, prohibition of unbanked, directed blood transfusion restricts the options of health practitioners, particularly in rural areas. Blood safety is also a significant concern, and efforts must be taken to decrease the risk of transfusion-transmitted infections and inform and treat donors who test positive. Lastly, blood banking systems need a centralized governing body to ensure fair prices for blood, promote comprehensive transfusion reporting, and increase system-wide transparency and accountability.Publication Global Surgery 2030: a roadmap for high income country actors(BMJ Publishing Group, 2016) Ng-Kamstra, Joshua S; Greenberg, Sarah L M; Abdullah, Fizan; Amado, Vanda; Anderson, Geoffrey A; Cossa, Matchecane; Costas-Chavarri, Ainhoa; Davies, Justine; Debas, Haile T; Dyer, George; Erdene, Sarnai; Farmer, Paul; Gaumnitz, Amber; Hagander, Lars; Haider, Adil; Leather, Andrew J M; Lin, Yihan; Marten, Robert; Marvin, Jeffrey T; McClain, Craig; Meara, John; Meheš, Mira; Mock, Charles; Mukhopadhyay, Swagoto; Orgoi, Sergelen; Prestero, Timothy; Price, Raymond R; Raykar, Nakul; Riesel, Johanna; Riviello, Robert; Rudy, Stephen M; Saluja, Saurabh; Sullivan, Richard; Tarpley, John L; Taylor, Robert H; Telemaque, Louis-Franck; Toma, Gabriel; Varghese, Asha; Walker, Melanie; Yamey, Gavin; Shrime, MarkThe Millennium Development Goals have ended and the Sustainable Development Goals have begun, marking a shift in the global health landscape. The frame of reference has changed from a focus on 8 development priorities to an expansive set of 17 interrelated goals intended to improve the well-being of all people. In this time of change, several groups, including the Lancet Commission on Global Surgery, have brought a critical problem to the fore: 5 billion people lack access to safe, affordable surgical and anaesthesia care when needed. The magnitude of this problem and the world's new focus on strengthening health systems mandate reimagined roles for and renewed commitments from high income country actors in global surgery. To discuss the way forward, on 6 May 2015, the Commission held its North American launch event in Boston, Massachusetts. Panels of experts outlined the current state of knowledge and agreed on the roles of surgical colleges and academic medical centres; trainees and training programmes; academia; global health funders; the biomedical devices industry, and news media and advocacy organisations in building sustainable, resilient surgical systems. This paper summarises these discussions and serves as a consensus statement providing practical advice to these groups. It traces a common policy agenda between major actors and provides a roadmap for maximising benefit to surgical patients worldwide. To close the access gap by 2030, individuals and organisations must work collectively, interprofessionally and globally. High income country actors must abandon colonial narratives and work alongside low and middle income country partners to build the surgical systems of the future.Publication Assessing the Brazilian surgical system with six surgical indicators: a descriptive and modelling study(BMJ, 2017) Massenburg, Benjamin B; Saluja, Saurabh; Jenny, Hillary; Raykar, Nakul; Ng-Kamstra, Josh; Guilloux, Aline G A; Scheffer, Mário C; Meara, John; Alonso, Nivaldo; Shrime, MarkBackground: Brazil boasts a health scheme that aspires to provide universal coverage, but its surgical system has rarely been analyzed. In an effort to strengthen surgical systems worldwide, the Lancet Commission on Global Surgery proposed collection of six standardized indicators: two-hour access to surgery, surgical workforce density, surgical volume, perioperative mortality rate (POMR), and protection against impoverishing and catastrophic expenditure. This study aims to characterize the Brazilian surgical health system with these newly devised indicators while gaining understanding on the complexity of the indicators themselves. Methods: Using Brazil’s national healthcare database, commonly reported healthcare variables were used to calculate or simulate the six surgical indicators. Access to surgery was calculated using hospital locations, surgical workforce density was calculated using locations of surgeons, anesthesiologists and obstetricians (SAO), and surgical volume and POMR were identified with surgical procedure codes. The rates of protection against impoverishing and catastrophic expenditure were modelled using cost of inpatient hospitalization and a gamma distribution of incomes based on GINI and GDP/capita. Findings: In 2014, SAO density is 34·7/100,000 population, surgical volume is 4,433 procedures/100,000 people and POMR is 1·71%. 79·4% of surgical patients are protected against impoverishing expenditure and 84·6% were protected against catastrophic expenditure due to surgery each year. Two-hour access to surgery was not able to be calculated from national health data, but a proxy measure suggested that 97·2% of the population has two-hour access to a hospital that may be able to provide surgery. Geographic disparities were seen in all indicators. Interpretation: Brazil‘s public surgical system meets several key benchmarks. Geographic disparities, however, are substantial and raise concerns of equity. Policies should focus on stimulating appropriate geographic allocation of the surgical workforce. In some cases, where benchmarks for each indicator are met, supplemental analysis can further inform our understanding of health systems. This measured and systematic evaluation of surgical systems should be encouraged for all nations seeking to better understand their surgical systems. Funding: There was no funding for this study.Publication The How Project: understanding contextual challenges to global surgical care provision in low-resource settings(BMJ, 2016) Raykar, Nakul; Yorlets, Rachel; Liu, Charles; Goldman, Roberta; Greenberg, Sarah Louise Mather; Kotagal, Meera; Farmer, Paul; Meara, John; Roy, Nobhojit; Gillies, Rowan DPublication New global surgical and anaesthesia indicators in the World Development Indicators dataset(BMJ Publishing Group, 2017) Raykar, Nakul; Ng-Kamstra, Joshua S; Bickler, Stephen; Davies, Justine; Greenberg, Sarah L M; Hagander, Lars; Johnson, Walt; Leather, Andrew J M; McQueen, K A Kelly; Mukhopadhyay, Swagoto; Suzuki, Emi; Weiser, Thomas; Shrime, Mark; G Meara, John