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      Global Surgery – Informing National Strategies for Scaling Up Surgery in Sub-Saharan Africa

      editorial

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          Abstract

          Surgery has the potential to address one of the largest, neglected burdens of disease in low- and middle-income countries (LMICs), especially in sub-Saharan Africa (SSA). The Lancet Commission on Global Surgery (LCoGS) has provided a blueprint for a systems approach to making safe emergency and elective surgery accessible and affordable and has started to enable African governments to develop national surgical plans. This editorial outlines an important gap, which is the need for surgical systems research, especially at district hospitals which are the first point of surgical care for rural communities, to inform the implementation of country plans. Using the Lancet Commission as a starting point and illustrated by two European Union (EU) funded research projects, we point to the need for implementation research to develop and evaluate contextualised strategies. As illustrated by the case study of Zambia, coordination by global and external stakeholders can enable governments to lead national scale-up of essential surgery, supported by national partners including surgical specialist associations.

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          Global access to surgical care: a modelling study.

          Blake C Alkire, Nakul Raykar, Mark G. Shrime … (2015)
          More than 2 billion people are unable to receive surgical care based on operating theatre density alone. The vision of the Lancet Commission on Global Surgery is universal access to safe, affordable surgical and anaesthesia care when needed. We aimed to estimate the number of individuals worldwide without access to surgical services as defined by the Commission's vision.
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            Essential surgery: key messages from Disease Control Priorities, 3rd edition.

            Charles Mock, Peter Donkor, Atul A Gawande … (2015)
            The World Bank will publish the nine volumes of Disease Control Priorities, 3rd edition, in 2015-16. Volume 1--Essential Surgery--identifies 44 surgical procedures as essential on the basis that they address substantial needs, are cost effective, and are feasible to implement. This report summarises and critically assesses the volume's five key findings. First, provision of essential surgical procedures would avert about 1·5 million deaths a year, or 6-7% of all avertable deaths in low-income and middle-income countries. Second, essential surgical procedures rank among the most cost effective of all health interventions. The surgical platform of the first-level hospital delivers 28 of the 44 essential procedures, making investment in this platform also highly cost effective. Third, measures to expand access to surgery, such as task sharing, have been shown to be safe and effective while countries make long-term investments in building surgical and anaesthesia workforces. Because emergency procedures constitute 23 of the 28 procedures provided at first-level hospitals, expansion of access requires that such facilities be widely geographically diffused. Fourth, substantial disparities remain in the safety of surgical care, driven by high perioperative mortality rates including anaesthesia-related deaths in low-income and middle-income countries. Feasible measures, such as WHO's Surgical Safety Checklist, have led to improvements in safety and quality. Fifth, the large burden of surgical disorders, cost-effectiveness of essential surgery, and strong public demand for surgical services suggest that universal coverage of essential surgery should be financed early on the path to universal health coverage. We point to estimates that full coverage of the component of universal coverage of essential surgery applicable to first-level hospitals would require just over US$3 billion annually of additional spending and yield a benefit-cost ratio of more than 10:1. It would efficiently and equitably provide health benefits, financial protection, and contributions to stronger health systems.
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              World Health Assembly Resolution WHA68.15: "Strengthening Emergency and Essential Surgical Care and Anesthesia as a Component of Universal Health Coverage"—Addressing the Public Health Gaps Arising from Lack of Safe, Affordable and Accessible Surgical and Anesthetic Services.

              Raymond Price, Emmanuel Makasa, Michael Hollands (2015)
              On May 22 2015, the 68th World Health Assembly (WHA) adopted resolution WHA68.15, "Strengthening emergency and essential surgical care and anesthesia as a component of universal health coverage (UHC)." For the first time, governments worldwide acknowledged and recognized surgery and anesthesia as key components of UHC and health systems strengthening. The resolution details and outlines the highest level of political commitments to address the public health gaps arising from lack of safe, affordable, and accessible surgical and anesthetic services in an integrated approach. This article reviews the background of resolution WHA68.15 and discusses how it can be of use to surgeons, anesthetists, advanced practice clinicians, nurses, and others caring for the surgical patients, especially in low- and middle-income countries.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Int J Health Policy Manag
                Journal ID (iso-abbrev): Int J Health Policy Manag
                Journal ID (publisher-id): Kerman University of Medical Sciences
                Journal ID (publisher-id): Int J Health Policy Manag
                Title: International Journal of Health Policy and Management
                Publisher: Kerman University of Medical Sciences
                ISSN (Electronic): 2322-5939
                Publication date Collection: June 2018
                Publication date (Electronic): 08 April 2018
                Volume: 7
                Issue: 6
                Pages: 481-484
                Affiliations
                1Royal College of Surgeons in Ireland, Dublin 2, Ireland.
                2Radboud University Medical Centre, Nijmegen, The Netherlands.
                Author notes
                [* ] Correspondence to: Jakub Gajewski Email: jakubgajewski@ 123456rcsi.ie
                Article
                DOI: 10.15171/ijhpm.2018.27
                PMC ID: 6015509
                PubMed ID: 29935124
                SO-VID: ec0f639b-95e9-4321-ba60-18318253b31c
                Copyright © © 2018 The Author(s); Published by Kerman University of Medical Sciences
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 23 January 2018
                Date accepted : 14 March 2018
                Page count
                References: 38, Pages: 4
                Categories
                Subject: Editorial

                Keywords: global surgery,africa,systems approach,national surgical plans
                Data availability:
                Keywords: global surgery, africa, systems approach, national surgical plans

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