SEATTLE — The tremendous progress made in global health over the past 25 years is somewhat sullied by its inequity. Advancements in health technology have been negated in low and middle-income countries (LMICs) due to deteriorating surgical and anesthetic care. Lagging surgical healthcare in poor countries, particularly in rural areas, contributes to an overwhelmed and inoperative health system unable to meet the increasing needs of people.
Surgical and anesthetic care is vital for a strong health system to meet a wide range of global health challenges, but in reality it is falling behind in many countries. According to Paul Farmer, co-founder of Partners In Health, “surgery is the neglected stepchild of global health.”
Safe and affordable surgical care is inaccessible to five billion people. The situation is worse in LMICs, where nine out of ten people do not receive the required surgical treatment. Only six percent of the 313 million surgical procedures worldwide occur in the poorest countries, where an additional 143 million lifesaving and disability preventing procedures are needed. Sub-Saharan Africa and south Asia have the highest unmet needs, where treatable conditions such as appendicitis, fractures, cardiovascular diseases, hernia and forms of cancer have high fatality rates.
About 32.9 percent (16.9 million) lives lost in 2010 were due to lack of surgical care. This is greater than the cumulative loss of life due to HIV/AIDS, tuberculosis and malaria. The marginalized populations in the poor regions of LMICs are the most vulnerable in the absence of lifesaving surgical care. Compared to the 14.9 percent without surgical access in high-income countries, approximately 94 percent lack access to surgical and anesthesia care in LMICs.
The ability to receive appropriate surgical healthcare is dependent on three primary factors, affordability, accessibility and availability. Lancet Commission on Global Surgery used the Three Delays framework to elaborate on the critical impediments faced by vulnerable populations in LMICs. The first delay refers to financial issues, cultural predispositions, geographical limitations and lack of awareness of available services; the second is caused by unreasonable distances to healthcare facilities or inadequate transportation; the third delay occurs at the healthcare facilities where lack of medical personnel and inadequate infrastructure leads to inability in receiving the emergent operative care needed.
Inadequate surgical healthcare also impedes economic growth and development goals. According to Jim Kim, President of the World Bank, 81 million people face debilitating poverty annually due to the catastrophic expenditure of accessing surgical and anesthetic care.
The cost of alleviating the inadequacies of surgical care in LMICs would be significantly less than the anticipated economic output loss incurred due to untreated conditions. The Lancet Commission estimates that approximately $420 billion is needed to balance the inequity by 2030. In contrast, the disparity will result in a global economic loss of $20.7 trillion, $12.3 trillion of which will be borne by LMICs with the worst surgical healthcare.
In his address to the first assembly of the Lancet Commission, Kim said “surgery is an indivisible, indispensable part of health care” and gave impetus to the global health community to eliminate imbalance in surgical healthcare. According to Lancet Commission, the ultimate responsibility of scaling up surgical care falls upon national governments and ministries of health but it earnestly appealed to global health agencies, academic institutions, charitable organizations and professional associations to aid the LMICs in achieving this critical goal.
Lancet Commission’s report, Global Surgery 2030, outlines fundamental strategies that the international community can adopt to support social justice and healthcare equity. Recommendations for actions include:
- Providing targeted funding for surgical healthcare to help LMICs expand resources and develop infrastructure to meet the growing population needs.
- Fostering partnerships with national governments and local providers for workforce expansion through education and training to promote sustainable development.
- Supporting financial policies such as universal health coverage (UHC) to safeguard populations from surgical care-related financial catastrophes in LMICs.
- Providing research support by promoting epidemiological, health policy and clinical research to enable safe and affordable access to surgical treatments to all sectors of the population.
- Promoting improved tracking and reporting of surgical indicators through technical assistance and policy support.
- Increasing research, development and financing for cost-effective, sturdy and low maintenance surgical and anesthesia equipment and technology in collaboration with LMIC partners.
The Lancet Commission also urged the global health community to realize surgical care’s critical role in the Sustainable Development Goals. It called for international collective action to help the LMICs build an equitable and resilient healthcare system for the millions deprived of lifesaving procedures. According to Kim, making surgical healthcare accessible and affordable for all is not only a moral imperative, “it is also important to ending extreme poverty and boosting shared prosperity.”
– Preeti Yadav