Search

BackgroundIndicators to evaluate progress towards timely access to safe surgical, anaesthesia, and obstetric (SAO) care were proposed in 2015 by the Lancet Commission on Global Surgery. These aimed to capture access to surgery, surgical workforce, surgical volume, perioperative mortality rate, and catastrophic and impoverishing financial consequences of surgery. Despite being rapidly taken up by practitioners, data points from which to derive the indicators were not defined, limiting comparability across time or settings. We convened global experts to evaluate and explicitly define-for the first time-the indicators to improve comparability and support achievement of 2030 goals to improve access to safe affordable surgical and anaesthesia care globally.Methods and findingsThe Utstein process for developing and reporting guidelines through a consensus building process was followed. In-person discussions at a 2-day meeting were followed by an iterative process conducted by email and virtual group meetings until consensus was reached. The meeting was held between June 16 to 18, 2019; discussions continued until August 2020. Participants consisted of experts in surgery, anaesthesia, and obstetric care, data science, and health indicators from high-, middle-, and low-income countries. Considering each of the 6 indicators in turn, we refined overarching descriptions and agreed upon data points needed for construction of each indicator at current time (basic data points), and as each evolves over 2 to 5 (intermediate) and >5 year (full) time frames. We removed one of the original 6 indicators (one of 2 financial risk protection indicators was eliminated) and refined descriptions and defined data points required to construct the 5 remaining indicators: geospatial access, workforce, surgical volume, perioperative mortality, and catastrophic expenditure. A strength of the process was the number of people from global institutes and multilateral agencies involved in the collection and reporting of global health metrics; a limitation was the limited number of participants from low- or middle-income countries-who only made up 21% of the total attendees.ConclusionsTo track global progress towards timely access to quality SAO care, these indicators-at the basic level-should be implemented universally as soon as possible. Intermediate and full indicator sets should be achieved by all countries over time. Meanwhile, these evolutions can assist in the short term in developing national surgical plans and collecting more detailed data for research studies.

National level experiences, lessons learnt from the Millennium Development Goal (MDG) era coupled with the academic evidence and proposals generated by the Lancet Commission on Global Surgery (LCoGS) together with the economic arguments and recommendations from the World Bank Group's "Essential Surgery" Disease Control Priorities (DCP3) publication, provided the impetus for political commitments to improve surgical care capacity at the primary level of the healthcare system in low- and middle-income countries (LMICs) as part of their drive towards universal health coverage (UHC) in the form of World Health Organization (WHO) Resolution A68.15. This global commitment from governments must be followed up with development of a Global Action Plan and a global coordination mechanism supported by regional implementation frameworks on the part of the WHO in order for the organisation to better coordinate all stakeholders and sustain the technical support needed to develop and implement national surgical health policy in the form of National Surgical Obstetric and Anaesthesia Plans (NSOAPs). As expounded by Gajewski et al, data and research output on surgical care is essential to informing policy development and programme implementation. This area still remains a challenge in sub-Saharan Africa (SSA) but it is envisaged that countries will include this key component in their ongoing national surgical healthcare policy development and programme implementation. In the Zambian case study, research in the area of Global Surgery investment-the surgical workforce scale-up is used to demonstrate the important role of implementation research in the development and implementation of the Zambian NSOAP as well as the need for international collaborations to this end. Scale-up reviews informed by implementation research to evaluate progress on the commitments contained in Resolution A68.15 and Decision A70.22 are essential to sustain the momentum and to help maintain focus on the gaps in all countries. There are opportunities for non-state actors especially local sub-regional academic institutions, non-governmental organizations (NGOs) and private sector to play a key role in surgical healthcare policy development and implementation research. Collection of and better information management of standardised surgical care indicators is essential for such research, for bi-annual WHO progress reporting and for demonstration of impact to justify and encourage further investments in surgical care. [ABSTRACT FROM AUTHOR]

Background Despite high-level commitment from governments, national surgical healthcare policy development has been slower than expected across the Southern African Development Community (SADC). This regional survey study aims to identify perceived barriers to policy formulation and, where applicable, implementation. Methods A combination of convenience, purposive and snowball sampling techniques were used to distribute an electronic survey to SADC surgical care stakeholders. Adaptive questioning was utilised to evaluate perceived potential barriers by each respondent, including government support for national surgical policy, the existence of a taskforce, resourcing for policy development, and specific challenges mapped to domains of the National Surgical, Obstetric and Anaesthesia Plan (NSOAP) Manual. Results Of 182 participants that consented to participation, 60% (n=109) responded in full and 22% (n=40) logged a partial response that was included in the analysis. 14/16 SADC countries were represented. 60% of respondents identified as healthcare professionals, 23% were academics and 24% represented government; there was poor representation from NGOs, civil society and potential donors. Twenty-seven percent (n=32) of respondents indicated that their country's government supports and is driving the NSOAP development process. Financing (n=41, 82%) and stakeholder engagement (n=40, 80%) were the domains most commonly cited as barriers to developing a national surgical health plan. Respondents from three countries that had published NSOAPs cited inadequate integration into existing health plans and insufficient funding as common barriers to implementation. Conclusions There is a generalised perception of limited political conviction to drive national surgical improvement across the region, as well as funding and stakeholder engagement being significant barriers. For safe, timely, and affordable surgical care to become a reality, SADC governments need to exhibit strong leadership and engage potential funders (national treasury. [ABSTRACT FROM AUTHOR]

Background Diagnostics are foundational to effective health systems but remain widely unavailable worldwide, especially in low-income countries like Malawi. To achieve health equity in Malawi, it is necessary to assess the availability of essential diagnostics. Methods We analysed data collected during a nationwide survey of musculoskeletal trauma care capacity. We analysed the presence, availability, and reasons for unavailability of laboratory testing, vital signs monitoring, electrocardiography, and diagnostic radiology at all 25 district hospitals and 4 central hospitals in Malawi. We used geospatial models to estimate the proportion of the Malawian population with 1-hour and 2-hour access to these resources. Taking 1-hour access to most accurately represent geospatial coverage in the Malawian context, a hypothetical intervention was designed whereby diagnostic capacity improvement would be prioritized at selected hospitals to cover at least 75% of Malawians nationwide. Results Twelve of 29 hospitals had basic laboratory testing available when needed, covering an estimated 58% of Malawians with 1-hour access and 95% with 2-hour access. Vital signs monitoring was available when needed at 18 hospitals, covering an estimated 74% of Malawians with 1-hour access and 97% with 2-hour access. Six hospitals reported that electrocardiography was available when needed, covering an estimated 49% of Malawians with 1-hour access and 91% with 2-hour access. Four hospitals had x-ray capacity of adequate quality to make accurate diagnoses when needed, covering an estimated 39% of Malawians with 1-hour access and 86% with 2-hour access. Broken machinery, inadequate supplies, and inadequate staff training were common reasons for resource unavailability. Conclusions Essential diagnostics were found to be unavailable for many Malawians. By prioritizing capacity improvements for all 4 central hospitals and 11 district hospitals, over three-quarters of Malawians could have 1-hour access to laboratory testing, vital signs monitoring, electrocardiography, and diagnostic x-ray. These capacity improvements are essential to meet the needs of a growing population, especially in the context of the current COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

EAST and CENTRAL AFRICAN Journal of Surgery | VOLUME 24 | NUMBER 1 | APRIL 2019 3 journal.cosecsa.org Open Access PERSPECTIVE Building capacity for surgery, obstetrics and anesthesia in support of universal health coverage and achievement of the Sustainable Development Goals Blake Alkire 1,2, Abebe Bekele 3,4, Isabelle Citron 2, Emmanuel M. Makasa 5,6, John G. Meara 2,7, Bisola Onajin-Obembe 8,9, Lauri Romanzi 10, Mpoki Ulisubisya 11 1. Although the third sustainable development goal (SDG) is the only goal wholly dedicated to health, 29 health-related targets are spread across 11 of the 17 goals, underscoring the vital role of health in realizing all the SDG' s. 1,2 Central to the achievement of the health-related SDGs is the call for universal health coverage (UHC) in SDG target 3.8. Unfortunately, the current unmet need for safe surgical, obstetric and anesthesia care remains critically high: five out of every seven people globally - and more than 90% of the population in sub-Saharan Africa, South Asia, and Southeast Asia - cannot receive safe, affordable surgery and anesthesia care when needed. 25 WHA68.15 identified five key surgical areas of focus - surgical and anesthesia workforce, information management, service delivery, essential medicines, advocacy, and resource development - and recognized the central role of surgery and anesthesia care in achieving universal health coverage; importantly, countries unanimously committed to improving their capacity to deliver surgical care at the district hospital level as a means to attaining UHC. [Extracted from the article]

Access to equitable, safe, affordable, timely, and quality surgical healthcare in Africa remains limited. Few African countries have surgical healthcare plans or policies. Where these exist, there are significant gaps in dissemination, funding, and implementation. A Pan-African Surgical Healthcare Forum (PASHeF) was initiated to address this. The inaugural forum was a two-day consensus conference of technocrats from African Ministries of Health hosted by the Honorable Minister for Health of Rwanda in Kigali. Through coordinated discussions, plenary sessions, working groups, and technocrat networking, they charted the path forward for national surgical healthcare policies and plans. Discussions were sparked by country experiences, and working groups focused on curated context-specific, face-validated questions. Documentation involved field notes, audio recordings, and artificial intelligence transcription. Data was coded using a constant comparative method to itemize delegates' observations, declarations, and recommendations, with member checking. A consensus statement was generated using an inclusive decision-making model. Thirty-two Ministries of Health were represented by 42 delegates who drafted and unanimously adopted the PASHeF 2023 Consensus Statement. This was a 50-point consensus addressing country commitment, leadership, financing, stakeholder mobilization, monitoring and evaluation, partnerships, and other aspects of national surgical healthcare planning in Africa. This consensus is the African roadmap and emphasizes implementation, the need for flexibility in policy development, and current opportunities and barriers. It emphasizes that community involvement and sustainability should undergird this planning, in addition to a focus on the entire spectrum of surgical healthcare, including prevention and rehabilitation. Delegates endorsed PASHeF as an annual event with a secretariat and recommended the creation of a Pan-African Surgical Healthcare Policy monitoring system, and that issues of surgical healthcare should be escalated as an agenda item on African Union and sub-regional ministerial meetings. African nations have embraced surgical healthcare policy as an imperative on their journey towards Universal Health Coverage., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Alayande et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)