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"

Abstract

In 2015, the Lancet Commission on Global Surgery (LCoGS) working groups developed a National Surgical, Obstetric, and Anesthesia Plan (NSOAP) framework to guide national surgical system development globally predicated on six data points (indicators) which can assess surgical systems. Zambia as well as other subSaharan Africa (SSA) countries have forged ahead in designing and implementing interventions based on LCoGS indicators collected to inform NSOAP. Concurrently, the Zambian team and others have recognized the need for rigorous scientific inquiry to assess and iteratively improve upon the NSOAP process and outputs. Based on the Zambian experience, as well as that of ours in Colombia, we have identified "core principles" through convergent works which inform a scientific framework through which NSOAP can be evaluated. We propose that when contextualized, participatory action research (PAR) and dissemination and implementation science are methodologies upon which a robust framework can be developed to achieving objective and iterative NSOAP evaluation, and ultimately universal health coverage as envisioned by the World Health Organization (WHO).

What is ‘global surgery’? Defining the multidisciplinary interface between surgery, anaesthesia and public health

“…The World Health Assembly in 2015 unanimously passed resolution 68.15, calling for its members to recognise this care as a critical and integral component of universal health coverage 80. Subsequent work towards developing and implementing new National Surgical Obstetric and Anaesthetic Plans (NSOAPs) demonstrates the response to this call 81. These support surgical system strengthening through a three-step process, consisting of a national baseline assessment, facility assessments and national planning, which is fully integrated into a country’s national health strategy 82.…”

Global Surgery Priorities: A Response to Recent Commentaries

“…We welcome the five published responses 1-5 to our editorial, 6 which outlined a research agenda for making surgery accessible in low- and middle-income country settings, where it is most needed. The commentators represent a good mix of academics, researchers and advocacy specialists, which demonstrates the growing global commitment to working together in the ‘empirically evolving global surgery systems science.’ 3 There is considerable consensus in the messages, including the importance of collaborative research approaches, adapted to country contexts; a focus on district population needs; and the use of standardised routine data collection and evaluation methods. Here, we briefly touch on some important new perspectives and some diverging ones.…”

“…Most importantly, global initiatives need to ensure local relevance through engagement with country level stakeholders, who are in a position to lead on national and sub-national implementation of agreed activities. To achieve maximum impact, such interventions need to be designed and implemented as multi-country projects, to ensure cross-country learning; and use appropriate PAR methods 3 and fit-for-purpose standardised tools and metrics. 2,3…”

“…To achieve maximum impact, such interventions need to be designed and implemented as multi-country projects, to ensure cross-country learning; and use appropriate PAR methods 3 and fit-for-purpose standardised tools and metrics. 2,3…”

“…Peck and Hanna describe a bottom-up approach in Latin America to incorporating a community perspective on data collection and national surgical planning. In Africa, NSOAP development has often been “based on empirical observation and in-country experience by identified stakeholders.” 3 However, the experience drawn on is usually that of specialist surgeons, who may have limited understanding of the reality of surgery at district hospitals. In many sub-Saharan African countries, district surgery is mainly or wholly provided by non-specialists, including general medical officers and non-physician clinicians.…”