Improving Access to Quality

Health
Services
Through
HighUniversity
of Utah
Global Health
Tech Interventions in LMICs
Laparoscopy
Developing a Roadfor
Mapll:
A Story of Two Countries
Prince Mahidol Award Conference
Jan 26, 2016

Colombia
-

Area:

1,138,910 sq km

Population:

47.8 Mill (2014)

23.7 Mill (1973)

GDP/Capita:

$ 7,903 (2014)
$ 435 (1973)

Life expectancy: 73.81 (2014)

61.93 (1973)

TFR:

1.92 (2014)
4.86 (1973)

Source: World Development Indicators, The World Bank

1973: First Tubal Ligation by Laparoscopy at

Profamilia
Source and Picture: PROFAMILIA Website, accessed Jan 8, 2016

Female Sterilization (Procedure/Total)

Profamilia - Colombia
(1972 2010)
80000

Transition Project ends

Law 100/93
70000
60000
50000
40000
30000
20000

10000

1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010

Laparoscopy

Minilap

Total

Source: Gerencia de Evaluacion e Investigacion, PROFAMILIA

Female Sterilization
Profamilia - Colombia
(Various Indicators)

Quality
- Mortality (Laparoscopy 1979-2010):
- Mortality (Minilaparotomy 1979 2010):

2.16/100,000
2.23/100,000

Costs
- Laparoscopy:
- Laparotomy:

$ 60 (2010)
~ $ 120 (2010)

Fees
- Subsidized recovery charges (BTP):
- Official price list (after Law 100):

$5 $10
$ 200

Source: Gerencia Salud Sexual y Reproductiva, PROFAMILIA

Colombia Mongolia
GDP Per Capita Comparison (US $ Nominal)
(1960 2014)
9,000.00
8,000.00
7,000.00
6,000.00

Program to improve
access to affordable
quality surgery in
Mongolia

5,000.00
4,000.00

Profamilia starts
offering laparoscopy

3,000.00
2,000.00
1,000.00

1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014

Colombia

Mongolia

Source: World Development Indicators, The World Bank

Mongolia
-

Area:

1,564,116 sq km

Population:

2.91 Mill (2014)

2.4 Mill (2000)

GDP/Capita:

$ 4,129 (2014)
$ 474 (2000)

Life expectancy: 69.06 (2014)

62.91 (2000)

TFR:

2.66 (2014)
2.1 (2000)

Source: World Development Indicators, The World Bank

49% of the population is nomadic

Source: World Journal of Surgery, Improving Surgical Care in Mongolia: A Model for Sustainable Development , 2012

Identified Needs in Mongolia

2005

Source: World Journal of Surgery, Improving Surgical Care in Mongolia: A Model for Sustainable Development , 2012

Regional Diagnostic Treatment

Referral Centers Mongolia

Source: World Journal of Surgery, Improving Surgical Care in Mongolia: A Model for Sustainable Development , 2012

Cholecystectomies in Mongolia
Total Procedures and Types
(2005 2013)

Cholecystectomies in Mongolia
Laparoscopy Vs. Open
(2005 2013)

Conclusions
Programs in Colombia and Mongolia started sophisticated surgical
programs at points in which their economies were less developed than they
are today.
Profamilia (private sector) could develop sustainable programs after years of
donor dependency (useful for public sector as well).
More developed surgical technologies favored access expansion and quality
improvement.

Relatively sophisticated solutions can present quality advantages but also

significant cost reductions, even for LMICs.
New technologies can offer important advantages in the quest for UHC