A comparative analysis of the health, financial, distributive, and cost-effectiveness impacts of maxillofacial surgery in Guinea

Abstract

Background: Non-governmental organizations (NGOs) play a substantive role in the delivery of surgical services in low- and middle-income countries (LMICs). Assessment of their outcomes, especially as they relate to outcomes of surgery performed in the country, remains limited.

Methods: We performed a prospective analysis of maxillofacial surgery in Guinea. Outcomes of interest were changes in patient health, subjective well-being, financial status, hardship financing and catastrophic expenditure, equitable distribution of surgical access, and cost-effectiveness.

Results: We followed 569 patients requiring maxillofacial surgery in Conakry, Guinea, 114 of whom received care at local university hospitals, and 455 of whom received care with Mercy Ships, a surgical NGO. Patients were followed up for three months (local) and one year (NGO). All patients reported significant improvements in objective and subjective measures of health and financial status. Approximately half had to borrow and sell to get care, with NGO patients borrowing less on average. However, NGO patients had a higher risk of catastrophic expenditure (41.2% vs. 28.1%, p < 0.001). NGO patients were significantly poorer, whether financial status was measured by asset wealth or monthly income (p < 0.001). Finally, surgical care by the NGO was cost-effective.

Conclusions: In a prospective analysis of surgical patients in an LMIC, we found that surgery improves health and financial well-being. NGOs may be able to reach patients who would not be able to get care through their local system; however, this comes at the cost of increased initial financial risk. Finally, NGO-based surgical care is cost-effective.