Increasing Access to Surgical Services in Resource-constrained Settings

Author(s): J. von Schreeb*1, S. Luboga2, S. Macfarlane3, M. Kruk4
Affiliation(s): 1Division of International Health, Karoliniska Institute, Stockholm, Sweden, 2Department of surgery, Makere University, Kampala, Uganda, 3Global Health Sciences, University of California San Francisco, 4Health Management and Policy, University of Michigan, School of Public Health, Michigan, United States
Keywords: Surgery, district, hospitals, training
Background:

Surgical services provide important preventive and life-saving strategies. Contrary to prevailing opinion, essential surgical procedures can be provided in district hospitals at a cost per DALY equivalent to other well-accepted preventive procedures. An international group of health professionals met last year at the Rockefeller Foundation’s Bellagio Center to develop strategies to raise the profile of surgery and increase access in resource-constrained settings in Africa. The group agreed that the major limiting factor in providing access is the shortage of suitably skilled health workers at district hospitals. The presentation is compiled on behalf of the Bellagio Essential Surgery Group.

Summary/Objectives:

 The objectives of the presentation are to: 1) outline what is known about the unmet need for surgical services in Africa and gaps in our knowledge; 2) layout obstacles to access; 3) examine alternative strategies to increase appropriate workforce skills; and 4) call for wider partnerships to integrate surgery within primary healthcare and develop training strategies.

Results:

The results are based on a literature review conducted prior to the Bellagio Conference and a synthesis of experiences of participants from Eritrea, Ghana, Kenya, Mozambique, Southern Sudan, Sweden, Tanzania and Uganda, and USA. A significant burden of disease is attributable to surgical conditions in sub-Saharan Africa but that much more evidence needs to be generated in order to better target interventions. A major proportion of these conditions can be treated or prevented cost-effectively at the first referral level but that this will require investments in facility infrastructures and in the training of non-surgeons to perform basic life saving general and obstetrical surgery. Preventive and curative programmes to address basic surgical conditions could strengthen health systems in resource-constrained settings and every effort should be made to develop these programmes in an integrative manner. Preventive and curative surgical interventions are essential to health systems and should to be integrated into primary healthcare strategies.

Lessons learned:

More effort is required to raise the profile of surgery on national and international agendas. In the first instance, there is need for: 1) more research to fill gaps in knowledge; 2) demonstration models of provision of surgical services at district level; and 3) sharing, through partnerships, of country experience in training non-surgeons in basic surgical procedures.

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