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

Document Type : Editorial

Authors

1 Royal College of Surgeons in Ireland, Dublin 2, Ireland

2 Radboud University Medical Centre, Nijmegen, The Netherlands

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.

Highlights

Commentaries Published on this Paper

  • Progress in Global Surgery; Comment on “Global Surgery – Informing National Strategies for Scaling Up Surgery in Sub-Saharan Africa”

            Abstract | PDF

  • Local Research Catalyzes National Surgical Planning; Comment on “Global Surgery – Informing National Strategies for Scaling Up Surgery in Sub-Saharan Africa”

            Abstract | PDF

  • Global Surgery – Redirecting Strategies for a Global Research Agenda; Comment on “Global Surgery – Informing National Strategies for Scaling Up Surgery in Sub-Saharan Africa”

            Abstract | PDF

  • The National Surgical, Obstetric, and Anesthesia Plan (NSOAP): Recognition and Definition of an Empirically Evolving Global Surgery Systems Science; Comment on “Global Surgery – Informing National Strategies for Scaling Up Surgery in Sub-Saharan Africa”

            Abstract | PDF

  • Universal Access to Surgical Care and Sustainable Development in Sub-Saharan Africa: A Case for Surgical Systems Research; Comment on “Global Surgery – Informing National Strategies for Scaling Up Surgery in Sub-Saharan Africa”

            Abstract | PDF

 

Authors' Response to the Commentaries

  • Global Surgery Priorities: A Response to Recent Commentaries

            Abstract | PDF

Keywords

Main Subjects

References

  1. Meara JG, Leather AJM, Hagander L, et al. Global Surgery 2030: Evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386(9993):569-624. doi:10.1016/S0140-6736(15)60160-X
  2. Esquivel MM, Uribe-Leitz T, Makasa E, et al. Mapping Disparities in Access to Safe, Timely, and Essential Surgical Care in Zambia. JAMA Surg. 2016;151(11):1064. doi:10.1001/jamasurg.2016.2303
  3. Alkire BC, Raykar NP, Shrime MG, et al. Global access to surgical care: A modelling study. Lancet Glob Health. 2015;3(6):e316-e323. doi:10.1016/S2214-109X(15)70115-4
  4. Grimes CE, Law RSL, Borgstein ES, Mkandawire NC, Lavy CBD. Systematic Review of Met and Unmet Need of Surgical Disease in Rural Sub-Saharan Africa. World J Surg. 2012;36(1):8-23. doi:10.1007/s00268-011-1330-1
  5. Ozgediz D, Riviello R. The “Other” Neglected Diseases in Global Public Health: Surgical Conditions in Sub-Saharan Africa. PLoS Med. 2008;5(6):e121. doi:10.1371/journal.pmed.0050121
  6. Weiser TG, Regenbogen SE, Thompson KD, et al. An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet. 2008;372(9633):139-144. doi:10.1016/S0140-6736(08)60878-8
  7. Gosselin RA, Thind A, Bellardinelli A. Cost/DALY Averted in a small hospital in Sierra Leone: what is the relative contribution of different services? World J Surg. 2006;30(4):505-511. doi:10.1007/s00268-005-0609-5
  8. Mock CN, Donkor P, Gawande A, Jamison DT, Kruk ME, Debas HT. Essential surgery: key messages from Disease Control Priorities, 3rd edition. Lancet. 2015;385(9983):2209-2219. doi:10.1016/s0140-6736(15)60091-5
  9. Chokotho L, Jacobsen KH, Burgess D, et al. Trauma and orthopaedic capacity of 267 hospitals in east central and southern Africa. Lancet. 2015;385:S17. doi:10.1016/S0140-6736(15)60812-1
  10. Gajewski J, Dharamshi R, Strader M, et al. Who accesses surgery at district level in sub-Saharan Africa? Evidence from Malawi and Zambia. Trop Med Int Health. 2017;22(12):1533-1541. doi:10.1111/tmi.12989
  11. Gajewski J, Mweemba C, Cheelo M, et al. Non-physician clinicians in rural Africa: Lessons from the medical licentiate programme in Zambia. Hum Resour Health. 2017;15(1). doi:10.1186/s12960-017-0233-0
  12. Mukhopadhyay S, Ojomo K, Nyberger K, Meara JG. Lancet Commission on Global Surgery. Iran J Pediatr. 2017;27(4):1-7.
  13. Citron I, Chokotho L, Lavy C. Prioritisation of Surgery in the National Health Strategic Plans of Africa: A Systematic Review. World J Surg. 2016;40(4):779-783. doi:10.1007/s00268-015-3333-9
  14. Republic of Zambia Ministry of Health National Surgical, Obstetric and Anaesthesia Strategic Plan 2017-2021. http://www.cosecsa.org/sites/default/files/NSOAP_May%202017.pdf. Accessed March 25, 2018.
  15. Program in Global Surgery and Social Change Harvard Medical School. https://www.pgssc.org/national-surgical-planning.  Accessed December 14, 2017.
  16. Bruno E, White MC, Baxter LS, et al. An Evaluation of Preparedness, Delivery and Impact of Surgical and Anesthesia Care in Madagascar: A Framework for a National Surgical Plan. World J Surg. 2017;41(5):1218-1224. doi:10.1007/s00268-016-3847-9
  17. Baxter LS, Ravelojaona VA, Rakotoarison HN, et al. An observational assessment of anesthesia capacity in madagascar as a prerequisite to the development of a national surgical plan. Anesth Analg. 2017;124(6):2001-2007. doi:10.1213/ANE.0000000000002049
  18. Nyaaba GN, Stronks K, De-Graft Aikins A, Kengne AP, Agyemang C. Tracing Africa’s progress towards implementing the Non-Communicable Diseases Global action plan 2013-2020: a synthesis of WHO country profile reports. BMC Public Health. 2017;17(1):1-13. doi:10.1186/s12889-017-4199-6
  19. Paina L, Peters DH. Understanding pathways for scaling up health services through the lens of complex adaptive systems. Health Policy Plan. 2012;27(5):365-373. doi:10.1093/heapol/czr054
  20. Dell AJ, Kahn D. Surgical Resources in South Africa: An International Comparison and Deficit Calculation. World J Surg. 2017:1-8. doi:10.1007/s00268-017-4176-3
  21. Rayne S, Burger S, Straten S Van, Biccard B, Phaahla MJ, Smith M. Setting the research and implementation agenda for equitable access to surgical care in South Africa. BMJ Glob Heal. 2017;2(2):e000170. doi:10.1136/bmjgh-2016-000170
  22. Walsh A, Brugha R, Byrne E. “The way the country has been carved up by researchers”: ethics and power in north-south public health research. Int J Equity Health. 2016;15(1):1-11. doi:10.1186/s12939-016-0488-4
  23. Lomazzi M, Borisch B, Laaser U. The Millennium Development Goals: Experiences, achievements and what’s next. Glob Health Action. 2014;7(Suppl 1):1-9. doi:10.3402/gha.v7.23695
  24. English M, English R, English A. Millennium development goals progress: A perspective from sub-Saharan Africa. Arch Dis Child. 2015;100(Suppl 1):S57-S58. doi:10.1136/archdischild-2013-305747
  25. Mukhopadhyay S, Lin Y, Mwaba P, et al. Implementing World Health Assembly Resolution 68.15: National surgical, obstetric, and anesthesia strategic plan development--the Zambian experience. Bull Am Coll Surg. 102(6):28-35.
  26. Lavy C, Tindall A, Steinlechner C, Mkandawire N, Chimangeni S. Surgery in Malawi - a national survey of activity in rural and urban hospitals. Ann R Coll Surg Engl. 2007;89(7):722-724. doi:10.1308/003588407X209329
  27. Mulwafu W, Chokotho L, Mkandawire N, et al. Trauma care in Malawi: A call to action. Malawi Med J. 2017;29(2):198-202. doi:10.4314/mmj.v29i43
  28. Cornelissen D, Mwapasa G, Gajewski J, et al. The Cost of Providing District-Level Surgery in Malawi. World J Surg. 2017;42(1):1-8. doi:10.1007/s00268-017-4166-5.
  29. Gajewski J, Conroy R, Bijlmakers L, et al. Quality of surgery in Malawi: comparison of patient-reported outcomes after hernia surgery between district and central hospitals. World J Surg. 2017. doi:10.1007/s00268-017-4385-9
  30. Chu K, Rosseel P, Gielis P, Ford N, Schrecker T. Surgical Task Shifting in Sub-Saharan Africa. PLoS Med. 2009;6(5):e1000078. doi:10.1371/journal.pmed.1000078
  31. Lewallen S, Etya’ale D, Kello AB, Courtright P. Non-physician cataract surgeons in Sub-Saharan Africa: Situation analysis. Trop Med Int Health. 2012;17(11):1405-1408. doi:10.1111/j.1365-3156.2012.03084.x
  32. Shawar YR, Shiffman J, Spiegel DA. Generation of political priority for global surgery: a qualitative policy analysis. Lancet Glob Health. 2015;3(8):e487--e495. doi:10.1016/S2214-109X(15)00098-4
  33. Mullan F, Frehywot S, Levy J, et Al., Tagar E, Ware I. Non-physician clinicians in 47 sub-Saharan African countries. Lancet. 2007;370(9605):2158-2163. doi:10.1016/S0140-6736(07)60785-5
  34. Price R, Makasa E, Hollands M. 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 a. World J Surg. 2015;39(9):2115-2125. doi:10.1007/s00268-015-3153-y
  35. Subramanian S, Naimoli J, Matsubayashi T, Peters DH. Do we have the right models for scaling up health services to achieve the millennium development goals? BMC Health Serv Res. 2011;11. doi:10.1186/1472-6963-11-336
  36. Brugha R, Donoghue M, Starling M, et al. The Global Fund: Managing great expectations. Lancet. 2004;364(9428):95-100. doi:10.1016/S0140-6736(04)16595-1
  37. Bruen C, Brugha R. A Ghost in the Machine? Politics in Global Health Policy. Int J Heal Policy Manag. 2014;3(1):1-4. doi:10.15171/ijhpm.2014.59
  38. Swanson CC, Atun R, Best A, et al. Strengthening health systems in low-income countries by enhancing organizational capacities and improving institutions. Global Health. 2015;11(1):1-8. doi:10.1186/s12992-015-0090-3

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History

  • Receive Date: 23 January 2018
  • Revise Date: 08 April 2018
  • Accept Date: 14 March 2018
  • First Publish Date: 01 June 2018

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