Global Surgical Care: 5 Billion in Need

Authored by ReSurge International

What you should know:

  • Surgical conditions – trauma, obstetric conditions, and infectious and non-communicable diseases – represent approximately 30 percent of the global burden of disease. Yet, approximately 5 billion people do not have access to safe, affordable surgical and anesthesia care, with only 6% of all surgical procedures benefiting the world’s poorest third.i

  • Each year, an estimated 16.9 -18 million people die as a result of surgically treatable conditions; millions more suffer from preventable disabilities. Moreover, 81 million people are impoverished seeking surgical care every year.ii

  • Surgical care is as cost effective as other public health initiatives ($82 per DALY for general surgery vs. $52 per DALY for BCG vaccine and $454 for antiretroviral drugs).iii The World Bank’s Disease Control Priorities 3 states that “essential surgical procedures rank among the most cost-effective of all health interventions.”iv For every $1 spent on strengthening local surgical capacity, $10 is generated through enhanced health and increased productivity.v

  • There is a shortage of 1 million surgical, anesthesia and obstetrical specialists in LMICs.vi This number is expected to more than double by 2030. Additional investment in nurses, non-physician providers, frontline health workers and support staff will be needed to ensure safe surgical care delivery.

Recommendations:

  • Integrate surgical care as part of US government global health funding and programs, especially for health systems strengthening, supporting resilient health workforce to respond to new and emerging public health threats, as well as maternal and child health and disaster response. Health targets for maternal health, health workforce and health systems strengthening and additional existing priorities cannot be achieved without access to surgical care.

  • Renew the U.S. government’s commitment to World Health Assembly Resolution 68.15, which acknowledges the role of strengthening emergency and essential surgical and anesthesia care as part of universal health coverage. Specifically,

    • Urge the U.S. Department of Health and Human Services (and other appropriate US government agencies) to support the coordinated collection of surgical care data and prioritize integrated health information systems platforms to aggregate data and track regional and global progress over time.

    • Advocate for the adoption of global standards for quality and safety by the WHO to support a skilled surgical and anesthesia workforce, and updated guidelines for equipment, infrastructure, medicines and supplies.

    • Support integration of surgical care as an integral component of USAID programs, cutting across maternal and child health, health systems strengthening and infectious

  • Prioritize greater accountability for U.S. efforts to expand access to health workers, including surgical- related workers. Congress should lead oversight into activities by the State Department, USAID, CDC, HHS and other relevant agencies and programs to help countries address health workforce gaps. (See Frontline Health Workers brief.)

Why is this investment important?

Surgical care represents a cost-effective and cross-cutting health service that is essential to treat and manage a broad range of conditions and disease categories, encompassing maternal and child health, trauma, non- communicable conditions such as cancer, diabetes and heart disease, and infectious diseases such as HIV/AIDS. Without investment in surgical care, millions will continue to suffer needless deaths, disabilities and related financial catastrophe every year, as a result of untreated but preventable surgical conditions.

The cost of inaction is too great. Failing to invest in surgical care is estimated to cost low- and middle-income countries as much as $12.3 trillion in lost GDP by 2030.vii This represents one of the most highly cost-effective global health interventions, contributing to the health and economic prosperity of a country.

Access to surgical care is also an important component of health systems strengthening and universal health coverage. In May 2015, 194 World Health Organization Member States, including the United States, provided their unanimous support for World Health Assembly Resolution 68.15, which recognizes the role of emergency and essential surgical care and anesthesia as part of universal health coverage. The United States was a cosponsor of this historic resolution, which helped to lay the groundwork for the integration of surgical care part of national health plans and as part of universal health coverage.

Resources:

  1. Lancet Commission on Global Surgery, http://www.lancetglobalsurgery.org/

  2. The G4 Alliance, http://www.theg4alliance.org/

  3. Essential Surgery | Disease Control Priorities Project, Third Addition, http://dcp-3.org/surgery

Contributors:

  1. Sara Anderson, Senior Advisor for Advocacy and Innovation, ReSurge International, sara@resurge.org

  2. Mira Mehes, Chief Operations Officer, G4 Alliance, an advocacy organization that includes five InterAction members.


i Meara, J.G., et al., Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic

1 Meara, J.G., et al., Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet, 2015. 386(9993).

ii Shrime, M.G., et al., Global burden of surgical disease: an estimation from the provider perspective. Lancet Glob Health, 2015. 3 Suppl 2: p. S8-9.

iii Zha, Y., et al., Global Estimation of Surgical Procedures Needed for Forcibly Displaced Persons. World J Surg, 2016. Chao, T.E., et al., Cost-effectiveness of surgery and its policy implications for global health: a systematic review and analysis. Lancet Glob Health, 2014. 2(6): p. e334-45.

iv Mock, C.N., Donkor, P., Gawande, A., Jamison, D.T., Kruk, M.E. and Debas, H.T., 2015. Essential surgery: key messages from Disease Control Priorities. The Lancet, 385(9983), pp.2209-2219.

v High-Level Panel of Eminent Persons on Post-2015 Development Agenda. A New Global Partnership: Eradicate Poverty and transform Economies through sustainable Development: The Report of the High-Level Panel of Eminent Persons on the Post-2015 Development Agenda. United Nations Publication. 2013.

vi Meara, J.G., et al., Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet, 2015. 386(9993).

vii Shrime, M.G., et al., Global burden of surgical disease: an estimation from the provider perspective. Lancet Glob Health, 2015. 3 Suppl 2: p. S8-9.

 

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