Enhancing Access for Essential surgical and anesthesia care at Primary Healthcare Settings in Low-Resource Settings: A Scoping Review Protocol

Introduction: Access for safe, timely, and affordable surgical and anesthesia care is one of the integral components of universal health coverage with a significant global burden of treatable surgical diseases. Five billion people lack safe and timely surgical and anesthesia care globally, with more than 80% from low-income countries. The Lancet Commission on Global Surgery showed 9 in 10 people in low income countries do not have access to essential surgical care. the problem associated with various factors, including infrastructure and manpower limitations. Recognizing the problem, there should be a tremendous strategy to give emphasis on improving access to safe, affordable, and timely surgical and anesthesia care. This scoping review aims to map existing evidence on perioperative anesthesia and surgical care access at the PHC level in LMICs to identify the barriers and enablers and suggest system-strengthening strategies for improving surgical care access in low-income countries. Methods: The review will follow the Joanna Briggs Institute (JBI) methodology for scoping reviews and adhere to the PRISMA-ScR checklist. The review protocol has been registered at Open Science Framework (OSF). A comprehensive search strategy will be developed using a combination of key terms from various databases to generate published articles published between 2015 and 2025 and gray literature. Article selection and screening will use predefined and iteratively refined selection criteria based on the Population Concept Context framework to independently screen titles and abstracts of citations from the search. The screening will be conducted by two independent reviewers with a predefined extraction tool. Disagreements will be solved by the two reviewers. The review will be reported in accordance with the PRISMA ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist.