ASCENDDECISION OBSERVATORY
HEALTH SYSTEMS · EXPLORATORY RESEARCH

Find the point where
the decision changes.

Explore what is known. Make assumptions visible.
Discover which uncertainty is worth resolving next.

FIELD NOTE 001 / SURGICAL ACCESS

More funding is only useful
if care can move through
the whole system.

Explore a bottleneck ↓
ILLUSTRATIVE SCENARIO12-month planning model · not a policy forecast
OBSERVATIONS, NOT CAUSAL EFFECTS

One world.
Many possible futures.

Public health-system indicators for every World Bank economy, including the Lancet Commission on Global Surgery indicators. National averages describe systems; they do not measure an individual's access to surgery.

THE WORLD IN CONTEXT

Explore the systems behind the numbers.

Drag to rotate · scroll or use + / − to zoom · click a country to select it. Grey means no observation for this indicator and year. Economies without 1:110m reference geometry (small states and territories) appear as capital markers.

Reference geometry is Natural Earth 1:110m and expresses no position on disputed territories. Markers use World Bank capital coordinates.

COMPARE THE OBSERVATIONS

A different perspective on the same systems

Inspect the observations

READ BEFORE INTERPRETING

A decision laboratory,
with its assumptions exposed.

What is real?

The World Lens uses retrieved World Bank and WHO Global Health Observatory observations for all 217 World Bank economies, 2000–2024, with the observation year always shown and missing values preserved. "Latest available" mode shows each economy's most recent observation, which can be many years old; fixed-year mode never carries values forward. The 3D globe colours Natural Earth 1:110m country geometry by the selected indicator (grey = no observation) and uses capital markers for small economies without geometry. Literature comes from Europe PMC; trial registrations from ClinicalTrials.gov. Snapshots remain inspectable when a service is unavailable.

The surgical indicators

Four of the six Lancet Commission on Global Surgery indicators are shown as compiled in World Development Indicators: specialist surgical workforce (surgeons, anaesthetists and obstetricians per 100,000), surgical volume (procedures per 100,000), and the shares of the population at risk of catastrophic and impoverishing expenditure if they needed surgery. The 2030 targets displayed are the Commission's: at least 20 providers and 5,000 procedures per 100,000, and 100% protection against both forms of expenditure. Two-hour geographic access and perioperative mortality are not available as comparable country series in these sources.

Geographic access (modelled)

ASCEND computes, for every economy, the share of the 2020 population living within one and two hours of the nearest healthcare facility and the population-weighted mean travel time, using the Malaria Atlas Project 2019 travel-time surfaces (motorised and walking-only; Weiss et al., Nature Medicine 2020) weighted by WorldPop 2020 counts at 1 km, over Natural Earth 1:10m polygons. The optional globe layer paints the same surface. These are modelled quantities about any facility, not the Lancet Commission's Bellwether 2-hour indicator, so they overstate surgical access; economies with fewer than half their population on valid pixels are left missing.

UN System Data Commons

Three indicators (UHC service coverage index, catastrophic health spending above 10%, physician density) carry a UN System Data Commons identifier (DCID). The refresh script stores each economy's latest UN Data Commons value next to the World Bank/WHO series and reports agreement at the latest common year; the country card shows both, and the "live" controls query the Commons' public V2 observation endpoint directly from your browser, replacing snapshot values only for the current session and only where marked. The same identifiers can be used with the UN System Data Commons MCP server by any MCP-capable research assistant; tools/undc_probe.py reproduces the discovery, metadata and retrieval steps used to select them.

What is hypothetical?

Every number in the Decision Landscape is an illustrative input. The model compares current practice, additional staffed surgical capacity, improved referrals, and both. It is not calibrated to a country, hospital, cancer type, or real financing policy.

The calculation

Each month: completions = minimum of patients available, referral throughput, usable capacity, and funded slots. Unresolved cases carry forward. Added budget buys staffed and funded slots; a referral programme first incurs its fixed cost. The comparison maximizes completed procedures, with spending and simpler interventions breaking ties.

What the colors mean

Regions show which strategy wins under a pair of capacity and referral assumptions. This is a sensitivity map, not a causal estimate, probability surface, or formal value-of-information analysis. Changing the objective could change the preferred strategy.

What remains unknown?

True unmet need, usable theatre capacity, implementation response, marginal costs, and patient outcomes require local evidence. National spending and life expectancy are contextual observations and never become model inputs automatically.

AI and evidence

AI assisted the development and source discovery for this prototype. The running app uses a transparent calculation and literature search, not a hidden language model. Publication relevance tags are keyword-based; they do not assess study quality or confirm causality.

Provenance

ASCEND is an independent research prototype. Earlier health-system explainers (including CADUCEUS) were an inspiration only; no framework, code or multipliers were reproduced. Indicator definitions and targets are credited to their publishers in the Source health panel.