Global Surgery 2030: a roadmap for high income country actors

Abstract

The Millennium Development Goals have ended and the Sustainable Development Goals have begun, marking a shift in the global health landscape. The frame of reference has changed from a focus on 8 development priorities to an expansive set of 17 interrelated goals intended to improve the well-being of all people. In this time of change, several groups, including the Lancet Commission on Global Surgery, have brought a critical problem to the fore: 5 billion people lack access to safe, affordable surgical and anaesthesia care when needed. The magnitude of this problem and the world's new focus on strengthening health systems mandate reimagined roles for and renewed commitments from high income country actors in global surgery. To discuss the way forward, on 6 May 2015, the Commission held its North American launch event in Boston, Massachusetts. Panels of experts outlined the current state of knowledge and agreed on the roles of surgical colleges and academic medical centres; trainees and training programmes; academia; global health funders; the biomedical devices industry, and news media and advocacy organisations in building sustainable, resilient surgical systems. This paper summarises these discussions and serves as a consensus statement providing practical advice to these groups. It traces a common policy agenda between major actors and provides a roadmap for maximising benefit to surgical patients worldwide. To close the access gap by 2030, individuals and organisations must work collectively, interprofessionally and globally. High income country actors must abandon colonial narratives and work alongside low and middle income country partners to build the surgical systems of the future.

Assessing the Brazilian surgical system with six surgical indicators: a descriptive and modelling study

“…2 Recognising the critical role of measurement in understanding and tracking the state of a surgical system, LCoGS proposed six standardised indicators, with associated benchmarks for two of them (table 1) and advocated for the incorporation of these indicators into existing mechanisms for health system assessments. While these indicators were developed through an expansive and iterative expert consultation, they have not yet been comprehensively applied at the national level.…”

Improving the care for elective surgical patients: post-operative ICU admission and outcome

“…However, surgery implies in its nature an aggressive invasion of the boundaries (4) of the body which may be associated with life-threatening complications and impaired quality of life (5). Furthermore, according to previous reports, 5 billion people are unable to access safe and affordable surgical and anaesthetic care (6)(7)(8). Safe surgery has been considered a public health priority (9) and many efforts have been invested to outline the best strategy to be undertaken for the sake of surgical patients.…”

Global surgery: A new agenda item for surgical training and professional partnership

“…The provision of surgical assistance in LMIC is not without risks to the host countries. Ill‐planned visits aimed at obtaining operative experiences and research opportunities solely for the benefit of the visiting surgeons could cause serious harm to the local systems and patients . A form of disguised colonialism, these exploitations carry with them fundamental human rights and ethical issues, exemplified in the past by the conduction of clinical trials in resource‐poor countries .…”

“…Ill-planned visits aimed at obtaining operative experiences and research opportunities solely for the benefit of the visiting surgeons could cause serious harm to the local systems and patients. 18 A form of disguised colonialism, these exploitations carry with them fundamental human rights and ethical issues, exemplified in the past by the conduction of clinical trials in resourcepoor countries. 19 However, even well-meaning surgical missions can pose risks due to undertraining of the visiting staff, the conduction of procedures that fail to meet local needs, inadequate perioperative care and the introduction of inappropriate skills and technologies that can constitute future burden.…”