By Dr Claude Martin jr. (Managing Director)
Surgical conditions represent a significant proportion of the global burden of disease, and therefore, surgery is an essential component of health systems. Achieving universal health coverage requires effective monitoring of access to surgery. Caesarean delivery, laparotomy, and treatment of open fractures should be standard procedures performed at first-level hospitals everywhere in the world.
In the six months since it began, the COVID-19 pandemic has placed extraordinary demands on health care systems around the world, including on surgery. Competing health objectives and resource reallocation threaten to delay the scale-up of surgical services in low- and middle-income countries (LMICs) where access to safe, affordable and timely care is poor.
The key aspiration of the Lancet Commission on Global Surgery was to promote resilience of surgical systems. The current pandemic provides an opportunity to stress-test those systems and identify fault-lines that may not be easily apparent outside of times of crisis.
The burden of surgical disease is vast but still unrecognized. In fact, surgical diseases kill more people each year than HIV, malaria, and TB combined. However, the capacity to provide the needed surgical care does not exist. There is a global deficit of 143 million surgical procedures per year, and consequently, surgically treatable conditions kill 17 million people each year.
Historically, global surgery has been most identified with medical missions””teams of surgeons who travel to resource-poor countries to perform procedures like cleft lip and palate repair or cataract surgery, which are unaffordable to most people in such settings. Such intermittent missions have saved lives and improved the health of many patients, but they have also been critiqued for not offering a lasting solution to the larger problem of health care access in those areas. As a result, the field has increasingly focused on building local capacities.
Surgery has a role across the entire spectrum of human disease, and conditions that can be surgically treated represent about 30 percent of the global burden of illness. But high out-of-pocket surgical costs push 33 million people into financial distress each year (and 48 million more when indirect costs like transportation are included).
Achieving the Commission’s 2030 goals would require a US$ 420 billion investment. This staggering cost could yield major returns, though: the report projects that the lack of surgery and anaesthesia would cost LMICs $12.3 trillion in that time span, a two percent drag on growth each year. Many surgeries are as cost-effective as other public-health measures. This includes treatment of open fractures.
Surgical services, including trauma and musculoskeletal care, are a prerequisite for the full attainment of local and global health goals. Universal health coverage and the health aspirations set out in the sustainable development goals (SDGs) are possible by ensuring that surgery and anaesthesia are available, accessible, safe, timely, and affordable.
If robust progress towards global surgery goals for 2030 is to continue, the stress points identified should be reinforced. An ongoing process of reappraisal and fortification will keep surgical systems in LMICs responsive to “old threats and new challenges”. Multiple opportunities exist to help realize the dream of surgical systems that are resilient to external shocks.