Global Surgery – The ‘neglected stepchild of global health’

This figure alone is staggering but when this is applied to geographical regions this statistic shows the true inequality of global surgery provision: more than 95% of the population in south Asia and central, eastern, and western sub-Saharan Africa do not have access to care. In Australasia, North America and Western Europe it is less than 5% of the population who lack access[2].

Global surgery, the ‘neglected stepchild of global health’[3], remains a looming health crisis within low and middle income countries. Seen by some as an expensive luxury, only to be afforded by the rich, the hurdles to improving access are clear and manifold. And yet apart from the humanitarian arguments for saving lives and reducing disability, the social and economic arguments for growing and strengthening the surgical workforce are compelling.

‘Although the financial cost of surgical expansion is significant ($420 billion), the cost of inaction on national incomes is much greater. The lost output will cost LMICs a total of $1.23 trillion dollars’ Lancet Commission on Global Surgery

National economies are not the only beneficiaries of increased surgical provision. Family economies are repeatedly disrupted as a result of a lack of access to surgical care. Relatively simple surgeries have the ability to change lives. Children who receive corrective surgery on their club foot are more likely to be able to work and provide for themselves. Women who are treated for obstetric fistula avoid the hugely devastating effects of being shunned and ostracised by their families and communities which often leave them unable to work.

From a personal point of view I feel indignant that an estimated one million women in low and middle income settings live with untreated obstetric fistula. Not only is fistula repair a relatively simple and straightforward procedure with life-changing outcomes for the woman concerned, but the fact that this is still an issue speaks to the failure of health systems to manage labour complications effectively.

The provision of SOTA or Surgery, Obstetrics, Trauma and Anaesthesia thus has a crucial role to play in reaching the Sustainable Development Goals (SDGs) and ensuring Universal Health Coverage (UHC) is achieved. In recent years moves to promote the importance of SOTA have been encouraging. From the World Health Organization Resolution on the importance of Surgical Care and Anaesthesia for UHC to the Lancet Commission on Global Surgery and increasing global groupings of advocacy enthusiasts as exemplified by the G4 Alliance, of which THET is an active member.

I am pleased that THET has been able to respond to some of the challenges over the years. From the inception of our work with Johnson & Johnson, we found a shared mission in our desire to improve basic surgical access within Africa. Since then we have developed the Africa Grants Programme and the latest round of grant awards has just been announced. Through this programme we have provided a funding stream for health partnerships seeking to improve safe surgery and anaesthesia – just a few of these projects are highlighted in this e-bulletin.

The Health Partnership Scheme, over the past seven years has also furthered our actions in global surgery. The anaesthesia programme in Uganda between the Association of Anaesthetists of Great Britain and Ireland (AAGBI) the World Federation of Societies of Anaesthesiologists (WFSA), and the Association of Anaesthesiologists of Uganda (AAU) is an excellent illustration of the impact these projects have had. Working to ensure safe paediatric anaesthesia in East and Central Africa, the project over two years, trained 379 anaesthesia providers within different health worker cadres in five African countries.

It remains frustrating to me that a subject with such stark statistics and an economic equation which is staggering still languishes somewhere near the bottom of the global health agenda. There are signs that there is an increasing interest from publications and global media outlets, and the renewed WHO commitment is a promising sign that the case for global surgery is being listened to and that our neglect of this ‘stepchild’ cannot be ignored any longer.

[1] http://www.thelancet.com/pdfs/journals/langlo/PIIS2214-109X(15)70115-4.pdf

[2] http://www.thelancet.com/pdfs/journals/langlo/PIIS2214-109X(15)70115-4.pdf

[3] https://kristof.blogs.nytimes.com/2016/04/20/surgery-the-neglected-stepchild-of-global-health/