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Making Surgery the Next Frontier in Global Health

WHA Poster 8 (Source- SS2020)
A mother who urgently needs a C-section. A child cradling a badly broken arm. A man who suddenly collapses at his office.

What do they have in common? They are part of the 5 billion people around the world who don’t have access to safe, affordable surgical and anesthesia care when they need it.

Each year, as many as 18 million people die as a result of surgically treatable conditions and millions more suffer from preventable disabilities. This is a global issue that impacts people of all socioeconomic and demographic backgrounds, but disproportionately affects the world’s most vulnerable and poorest populations.

Everyone should be able to access the surgical care they need quickly, safely and affordably

 In 2015, GE Foundation partnered with Jhpiego, Harvard Program in Global Surgery and Social Change, Assist International, and the G4 Alliance (Global Alliance for Surgical, Obstetric, Trauma and Anaesthesia Care) to create Safe Surgery 2020.

The goal is simple: to reduce preventable deaths from surgically treatable conditions. Safe Surgery 2020 aims to increase surgical volume by 50% and decrease surgery-related deaths by a third, eventually touching the lives of 50 million people by 2020. The program launched in Ethiopia in 2016 and has since expanded to Tanzania.

Failing to invest in surgical care is estimated to cost low- and middle-income countries as much as $12.3 trillion in lost GDP by 2030. According to the G4 Alliance, investing in surgical care cost-effectively improves the health, development and economic productivity of nations around the world.

The World Health Alliance: Reporting on progress

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Dr. John Meara. Director of the Program in Global Surgery and Social Change (PGSSC) at Harvard Medical School and Plastic Surgeon-in-Chief of the Department of Plastic & Oral Surgery at Boston Children’s Hospital

Earlier this week, representatives of the healthcare sector – private and public – discussed how they can urge healthcare systems to prioritize the role of surgical and anesthesia care globally during the Safe Surgery Side Event ahead of the 70th World Health Assembly (WHA) in Geneva, Switzerland. The WHA is the supreme decision-making body for the World Health Organization (WHO) and meets annually in May to determine the policies of the WHO. This year, global leaders will report on their progress in supporting the resolution to improve access to safe surgery.

Dr. John Meara spoke at the safe surgery event, titled From Commitment to Action: Partnerships to Strengthen Surgical and Anaesthesia Care for All. He is the Kletjian Professor of Global Surgery and the Director of the Program in Global Surgery & Social Change (PGSSC) at Harvard Medical School. He also co-chairs The Lancet Commission on Global Surgery to develop and assemble the best evidence on the state of surgery worldwide, to study the economics of surgical and anesthesia care delivery, and to develop strategies for improving access.

The Pulse had the chance to ask Dr. Meara about Safe Surgery 2020 and why it’s important to him – and the millions of people it hopes to reach worldwide.

What are the challenges of surgical and anesthesia care today?

 The biggest challenge is prioritizing surgery so it’s integrated into the overall health system planning. Surgery has been seen as too expensive and too complex, and has largely been ignored by the global public health community.

There’s also funding neglect for delivery, education, research and more. Most organizations still concentrate on vertical interventions, but we need horizontal funding that spans multiple areas.

There’s also a lack of strategic planning. Until recently – until the Lancet Commission – there was no country in the world that had a surgical strategic plan integrated into its national health plan. Now Zambia and Ethiopia do, and Tanzania and Rwanda are beginning the process of creating plans. Remember the quote from Alice in Wonderland: “If you don’t know where you are going, any road will do…”

What’s the role of data in this space?

We are operating in a “data-free zone” when it comes to surgical data. The WHO does not ask Ministries of Health (MOH)or surgical data. The World Bank has accepted the six Lancet Surgical indicators, but for them to be collected the WHO has to recognize them and ask for countries to collect that data.

The WHO must incorporate surgical data collection as part of the healthcare data it collects from countries – and then send that data to the World Bank for inclusion in the World Bank WDI (World Development Indicators) section. The World Bank has agreed to publish this surgical data and, in fact, has published the initial data collected as a result of The Lancet Commission on Global Surgery.

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How can we approach these challenges with fresh ideas?

We need to start seeing that surgery is a partner in health care delivery – not a competitor for scarce resources. Surgery adds value to every part of the health care delivery system.

Surgery is absolutely necessary if we are to achieve authentic health security and universal health coverage. “Pandemic Preparedness” will not make the world safe from pandemics – only horizontal health system strengthening that incorporates surgery can address the health deserts that exist and all countries of all income levels.

Financial risk protection is also critical to create the positive gross domestic product (GDP) benefits that can come from investments in surgery.

It is important to also recognize the power of the transferable impact of the surgical ecosystem to other care areas such as Oncology, Cardiology, Trauma and Maternal-Child Health.

How can partnerships accomplish these goals?

 We need to think about multi-stakeholder funding, including industry, for low- and middle-income countries. The investments that GE Foundation is making in the Safe Surgery 2020 project are exactly the kind of holistic thinking that is needed, addressing education, data collection and analysis, innovation, advocacy —and very importantly “accompaniment” at a national level.