Background Improvement in the surgical system requires intersectoral coordination. To achieve this, the development of National Surgical, Obstetric, and Anaesthesia Plans (NSOAPS) has been recommended. One of the first steps of NSOAP development is situational analysis. On the ground situational analyses can be resource intensive and often duplicative. In 2016, the Ministry of Health of Tanzania issued a directive for the creation of an NSOAP. This systematic review aimed to assess if a comprehensive situational analysis could be achieved with existing data. These data would be used for evidence-based priority setting for NSOAP development and streamline any additional data collection needed. Methods A systematic literature review of scientific literature, grey literature, and policy documents was performed as per PRISMA. Extraction was performed for all articles relating to the five NSOAPS domains: infrastructure, service delivery, workforce, information management, and financing. Results 1819 unique articles were generated. Full-text screening produced 135 eligible articles; 46 were relevant to surgical infrastructure, 53 to workforce, 81 to service delivery, 11 to finance, and 15 to information management. Rich qualitative and quantitative data were available for each domain. Conclusions Despite little systematic data collection around SOA, a thorough literature review provides significant evidence which often have a broader scope, longer timeline and better coverage than can be achieved through snapshot-stratified samples of directed on the ground assessments. Evidence from the review was used during stakeholder discussion to directly inform the NSOAP priorities in Tanzania.

Despite emergency and essential surgery and anaesthesia care being recognised as a part of Universal Health Coverage, 5 billion people worldwide lack access to safe, timely and affordable surgery and anaesthesia care. In Tanzania, 19% of all deaths and 17 % of disability-adjusted life years are attributable to conditions amenable to surgery. It is recommended that countries develop and implement National Surgical, Obstetric and Anesthesia Plans (NSOAPs) to systematically improve quality and access to surgical, obstetric and anaesthesia (SOA) care across six domains of the health system including (1) service delivery, (2) infrastructure, including equipment and supplies, (3) workforce, (4) information management, (5) finance and (6) Governance. This paper describes the NSOAP development, recommendations and lessons learnt from undertaking NSOAP development in Tanzania.The NSOAP development driven by the Ministry of Health Community Development Gender Elderly and Children involved broad consultation with over 200 stakeholders from across government, professional associations, clinicians, ancillary staff, civil society and patient organisations. The NSOAP describes time-bound, costed strategic objectives, outputs, activities and targets to improve each domain of the SOA system. The final NSOAP is ambitious but attainable, reflects on-the-ground priorities, aligns with existing health policy and costs an additional 3% of current healthcare expenditure.Tanzania is the third country to complete such a plan and the first to report on the NSOAP development in such detail. The NSOAP development in Tanzania provides a roadmap for other countries wishing to undertake a similar NSOAP development to strengthen their SOA system.

Nearly a third of the global burden of disease require availability of surgical and anesthetic services. However, five billion people currently lack access to safe, affordable surgical and anesthesia care. Each year, appendicitis, hernia, open fracture and other common, treatable surgical diseases result in millions of disabilities and deaths. This is in part due to lack of political will, financial resource allocation, and relevant policy measures. To address these glaring needs, the lancet commission on global surgery (LCoGS) was formed to identify the barriers to access of surgical and anesthesia care, and the current state of these services worldwide. Additionally, its purpose was to identify opportunities for improvement and development to provide safe surgery in low-income and middle-income settings. To address the needs of surgical and anesthesia services LCoGS created 5 key messages, a set of 6 core surgical system indicators, and a health system strengthening framework for national surgical care planning. These key outputs of the commission highlighted that a widespread expansion of surgical care improves overall health and welfare of populations and improved economic returns. The findings were published as a report in the spring of 2015 to facilitate increased surgical care access that was safe, affordable, and cost-effective particularly for low-income and middle-income countries. In this review article, we summarize this seminal report and ldquo; global surgery 2030: evidence and solutions for achieving health, welfare, and economic development and rdquo; published in the Lancet 2015.