Over the past twenty years, global health has focused primarily on individual diseases. This has led to remarkable reductions in death and disability from certain conditions. However, these gains have not been mirrored by similar improvements to health systems, integration of services, and hospital-based care, nor have they been fairly distributed amongst people of all socioeconomic standings.
A growing body of evidence demonstrates a large unmet need for surgical obstetric and anaesthetic care in many low and middle-income countries.
In the absence of surgical care, case-fatality rates are high for common, easily treatable conditions including appendicitis, hernia, fractures, obstructed labour, and breast and cervical cancer.
The emergence of this data, along with a shift in global health policy from disease-specific interventions to a strengthening of health systems approach in the developing world have all supported the emergence of a new interest in surgery, obstetrics and anaesthesia as a global health priority.
2015 was a turning point for global surgery. The World Bank, and the World Health assembly recognized surgery as an essential area for health development. The Lancet commission released a report on Global Surgery that addressed 5 key areas to promote change including:
Governments must provide support and resources to deploy health care providers (midwives, doctors, and other skilled maternity care providers, including specialists) in adequate numbers to meet population needs. Likewise, country-level workforce management is necessary to ensure optimal recruitment, distribution and retention of health workers; as well as supportive supervision and task shifting as needed to improve access to care. Professional associations play an important role in establishing norms for the regulation of health care workers and setting professional standards for their education and core competencies.
Beyond governments and professional associations, to achieve universal access to safe, timely and affordable surgical care, we need commitment from individuals who are willing to engage in building capacity in low and middle-income countries. There are existing networks between individuals and groups who engage in this work that can become the avenue for further development.
We are not talking about mere service provision, but a commitment to the training and professional development of local obstetric, surgical and anaesthesia providers and the evolution toward sustainable systems for the delivery of care.
Training partnerships, mentorship and research support are some of the ways high-income country clinicians and academics can improve access to essential surgical care around the world. Members of AGES and similar organizations have commenced this work and we are approaching the stage where some of these partnerships can be formalized to strengthen these relationships and build on the important work that is already being done.