Global Surgery System Strengthening: It Is All About the Right Metrics

Abstract

Progress in achieving "universal access to safe, affordable surgery, and anesthesia care when needed" is dependent on consensus not only about the key messages but also on what metrics should be used to set goals and measure progress. The Lancet Commission on Global Surgery not only achieved consensus on key messages but also recommended 6 key metrics to inform national surgical plans and monitor scale-up toward 2030. These metrics measure access to surgery, as well as its timeliness, safety, and affordability: (1) Two-hour access to the 3 Bellwether procedures (cesarean delivery, emergency laparotomy, and management of an open fracture); (2) Surgeon, Anesthetist, and Obstetrician workforce >20/100,000; (3) Surgical volume of 5000 procedures/100,000; (4) Reporting of perioperative mortality rate; and (5 and 6) Risk rates of catastrophic expenditure and impoverishment when requiring surgery. This article discusses the definition, validity, feasibility, relevance, and progress with each of these metrics. The authors share their experience of introducing the metrics in the Pacific and sub-Saharan Africa. We identify appropriate messages for each potential stakeholder-the patients, practitioners, providers (health services and hospitals), public (community), politicians, policymakers, and payers. We discuss progress toward the metrics being included in core indicator lists by the World Health Organization and the World Bank and how they have been, or may be, used to inform National Surgical Plans in low- and middle-income countries to scale-up the delivery of safe, affordable, and timely surgical and anesthesia care to all who need it.

Disparities in surgical care for children across Brazil: Use of geospatial analysis

“…Additional studies of these challenges may require capture of surgery-specific measures of health care quality such as perioperative mortality rates, as well as other general measures of health care quality. [28, 29]…”

Morbidity after surgical management of cervical cancer in low and middle income countries: A systematic review and meta-analysis

“…Data are particularly lacking from LICs. Developing registries to meet this gap is critical in addressing the global burden of non-communicable diseases including cancer[93], particularly with increasing access to adjuvant therapies in these settings. Inclusive access to the most basic cervical cancer management is lacking in LMIC and system strengthening is critical to changing this[94].…”

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"

“…Recent analysis of the validity of the LCoGS indicators suggests that they are effective in providing a meaningful and objective assessment of a surgical system’s capacity. 3 However, the process through which NSOAP is developed is self-defined and generated based on empiric observation and in-country experience by identified stakeholders. The present authors provocatively point out that there is no “strong empirical base” for this process and opine that perhaps without this, “national surgical plans will be unrealistic or remain aspirational.”…”