Generation of national political priority for surgery: a qualitative case study of three low-income and middle-income countries

Dare, Anna J; Bleicher, Josh; Lee, Katherine C.; Elobu, Alex E; Kamara, Thaim B.; Liko, Osborne; Luboga, Samuel; Danlop, Akule; Kune, Gabriel; Hagander, Lars; Leather, Andrew; Yamey, Gavin

doi:10.1016/s0140-6736(15)60849-2

Cited by 19 publications

(22 citation statements)

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“…This is changing and the importance of surgery to human health and welfare has been highlighted by several recent studies 2 -4 . For instance, 17 million of the 51 million people who died across the world in 2012 suffered from diseases needing surgical care 1,2 . Access to surgical care varies widely 3,4 . It has been estimated that less than one-third of the world's population has access to safe, timely and affordable surgery, and only 6 per cent of the 300 million surgical procedures performed each year take place in a low-or middle-income country (LMIC) despite one-third of the world's population living there 2 .…”

Section: Introductionmentioning

confidence: 99%

“…Surgery, however, contributes to the treatment of a very wide range of conditions and its significance may have been obscured by a disease‐based approach to international health. This is changing and the importance of surgery to human health and welfare has been highlighted by several recent studies. For instance, 17 million of the 51 million people who died across the world in 2012 suffered from diseases needing surgical care.…”

Section: Introductionmentioning

confidence: 99%

“…It has been estimated that less than one‐third of the world's population has access to safe, timely and affordable surgery, and only 6 per cent of the 300 million surgical procedures performed each year take place in a low‐ or middle‐income country (LMIC) despite one‐third of the world's population living there. There are firm moves, supported by the World Health Organization (WHO), to improve access to surgical care. However, safe surgery requires considerable infrastructure, and improving coverage should go hand in hand with quality assurance.…”

Section: Introductionmentioning

confidence: 99%

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Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Bhangu¹,

Fitzgerald²,

Ademuyiwa³

et al. 2016

Br J Surg

237

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Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low-or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI).Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Bhangu¹,

Fitzgerald²,

Ademuyiwa³

et al. 2016

Br J Surg

237

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“…Like many other countries in sub-Saharan Africa, surgical care is a low-to-moderate health priority in Uganda [ 8 ]. There are approximately 0.67 physicians per 100,000 people and 0.1 surgeons per 100,000 people [ 9 ], compared with 250 surgeons per 100,000 in the United States [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Quantifying the pediatric surgical need in Uganda: results of a nationwide cross-sectional, household survey

et al. 2016

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PurposeLittle is known about the prevalence of pediatric surgical conditions in low- and middle-income countries. Many children never seek medical care, thus the true prevalence of surgical conditions in children in Uganda is unknown. The objective of this study was to determine the prevalence of surgical conditions in children in Uganda.MethodsUsing the Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey, we enumerated 4248 individuals in 2315 households in 105 randomly selected clusters throughout Uganda. Children aged 0–18 were included if randomly selected from the household; for those who could not answer for themselves, parents served as surrogates.ResultsOf 2176 children surveyed, 160 (7.4 %) reported a currently untreated surgical condition. Lifetime prevalence of surgical conditions was 14.0 % (305/2176). The predominant cause of surgical conditions was trauma (48.4 %), followed by wounds (19.7 %), acquired deformities (16.2 %), and burns (12.5 %). Of 90 pediatric household deaths, 31.1 % were associated with a surgically treatable proximate cause of death (28/90 deaths).ConclusionAlthough some trauma-related surgical burden among children can be adequately addressed at district hospitals, the need for diagnostics, human resources, and curative services for more severe trauma cases, congenital deformities, and masses outweighs the current capacity of hospitals and trained pediatric surgeons in Uganda.

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“…Dare et al have explored the reasons why surgery is not currently prioritized on NHSPs [ 13 ]. They conclude that competing health priorities, in particular infectious disease, as well as resource constraint and poor framing of the importance of surgery all contribute significantly to the poor current status of surgery.…”

Section: Discussionmentioning

confidence: 99%

Prioritisation of Surgery in the National Health Strategic Plans of Africa: A Systematic Review

2015

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IntroductionDisease amenable to surgical intervention accounts for 11–15 % of world disability and there is increasing interest in surgery as a global public health issue. National Health Strategic Plans (NHSPs) reflect countries’ long-term health priorities, plans and targets. These plans were analysed to assess the prioritisation of surgery as a public health issue in Africa.MethodsNHSPs of 43 independent Sub-Saharan African countries available in the public domain in March 2014 in French or English were searched electronically for key terms: surg*, ortho*, trauma, cancer, appendic*, laparotomy, HIV, tuberculosis, malaria. They were then searched manually for disease prevalence, targets, and human resources.Results19 % of NHSPs had no mention of surgery or surgical conditions. 63 % had five or less mentions of surgery. HIV and malaria had 3772 mentions across all the policies, compared to surgery with only 376 mentions. Trauma had 239 mentions, while the common surgical conditions of appendicitis, laparotomy and hernia had no mentions at all. Over 95 % of NHSPs specifically mentioned the prevalence of HIV, tuberculosis, malaria, infant mortality and maternal mortality. Whereas, the most commonly mentioned surgical condition for which a prevalence was given was trauma, in only 47 % of policies. All NHSPs had plans and measurable targets for the reduction of HIV and tuberculosis. Of the total 4064 health targets, only 2 % were related to surgical conditions or surgical care. 33 % of policies had no surgical targets.DiscussionNHSPs are the best available measure of health service and planning priorities. It is clear from our findings that surgery is poorly represented and that surgical conditions and surgical treatment are not widely recognised as a public health priority. Greater prioritisation of surgery in national health strategic policies is required to build resilient surgical systems.

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Generation of national political priority for surgery: a qualitative case study of three low-income and middle-income countries

Cited by 19 publications

References 1 publication

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Quantifying the pediatric surgical need in Uganda: results of a nationwide cross-sectional, household survey

Prioritisation of Surgery in the National Health Strategic Plans of Africa: A Systematic Review

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