Sample of respondents.

BackgroundSurgical services are scarce with persisting inequalities in access across populations and regions globally. As the world’s most populous county, India’s surgical need is high and delivery rates estimated to be sub-par to meet need. There is a dearth of evidence, particularly sub-regional data, on surgical provisioning which is needed to aid planning.Aim and methodThis mixed-methods study examines the state of surgical care in Northeast India, specifically health care system capacity and barriers to surgical delivery. It involved a facility-based census and semi-structured interviews with surgeons and patients across four states in the region.ResultsAbdominal conditions constituted a large portion of the overall surgeries across public and private facilities in the region. Workloads varied among surgical providers across facilities. Task-shifting occurred, involving non-specialist nursing staff assisting doctors with surgical procedures or surgeons taking on anaesthetic tasks. Structural factors dis-incentivised facility-level investment in suitable infrastructure. Facility functionality was on average higher in private providers compared to public providers and private facilities offer a wider range of surgical procedures. Facilities in general had adequate laboratory testing capability, infrastructure and equipment. Public facilities often do not have surgeon available around the clock while both public and private facilities frequently lack adequate blood banking. Patients’ care pathways were shaped by facility-level shortages as well as personal preferences influenced by cost and distance to facilities.Discussion and conclusionSkewed workloads across facilities and regions indicate uneven surgical delivery, with potentially variable care quality and provider efficiency. The need for a more system-wide and inter-linked approach to referral coordination and human resource management is evident in the results. Existing task-shifting practices, along with incapacities induced by structural factors, signal the directions for possible policy action.背景 全球范围内，外科医疗服务资源匮乏，不同人群与地区间的医疗可及性始终存在显著不平等。作为全球人口最多的国家，印度的外科医疗需求规模庞大，而现有手术服务供给率据估算未达需求匹配标准。目前关于外科医疗供给的相关研究证据匮乏，尤其是亚区域层面的数据，而这类数据对于医疗规划制定至关重要。 研究目的与方法 本项混合方法研究聚焦印度东北部地区的外科医疗服务现状，重点考察该区域的医疗系统服务能力与外科手术开展面临的障碍。研究采用基于医疗机构的普查方法，并对该区域四个邦的外科医生与患者开展半结构化访谈。 研究结果 该区域公立与私立医疗机构的整体手术量中，腹部病症相关手术占比极高。不同医疗机构的外科医护人员工作量差异显著。存在任务分流现象：非专科护理人员协助医师开展外科手术，或外科医师承担麻醉相关工作。结构性因素抑制了医疗机构对适配基础设施的投入。整体而言，私立医疗机构的服务功能平均水平高于公立机构，且私立机构可开展的外科手术种类更为丰富。多数医疗机构具备充足的实验室检测能力、基础设施与设备。公立医疗机构往往无法提供24小时外科医师在岗服务，而公立与私立机构均普遍存在血库储备不足的问题。患者的诊疗路径既受医疗机构资源短缺的影响，也受自身对就医成本与就诊距离的偏好所塑造。 讨论与结论 不同医疗机构与地区间的工作量失衡，反映出外科医疗服务供给不均，可能导致医疗服务质量与医护人员效率参差不齐。研究结果显示，亟需建立更具系统性与跨机构联动性的转诊协调与人力资源管理模式。当前存在的任务分流实践，以及结构性因素引发的服务能力不足，为后续政策制定指明了可行方向。