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”

Document Type : Commentary


Department of Surgery, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA


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).


Main Subjects

  1. Gajewski J, Bijlmakers L, Brugha R. Global Surgery - Informing National Strategies for Scaling Up Surgery in Sub-Saharan Africa. Int J Health Policy Manag. 2018;7(6):481-484. doi:10.15171/ijhpm.2018.27
  2. Meara JG, Leather AJ, Hagander L, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386(9993):569-624. doi:10.1016/s0140-6736(15)60160-x
  3. Watters DA, Guest GD, Tangi V, Shrime MG, Meara JG. Global Surgery System Strengthening: It Is All About the Right Metrics. Anesth Analg. 2018;126(4):1329-1339. doi:10.1213/ane.0000000000002771
  4. Peck G, Saluja S, Blitzer DN, et al. Using global surgical indicators to improve trauma care in Latin America. Bull Am Coll Surg. 2017;102(4):11-16.
  5. Peck G, Blitzer D, Citron I, et al. Latin America Indicator Research Coalition examines prehospital care using a trauma systems application of LCoGS indicator 1. Bull Am Coll Surg. 2017;102(7):23-31.
  6. Peck G, Mejia Toro D, Ribeiro M, et al. Acute care surgery role in expanding the surgical workforce in Latin America. Bull Am Coll Surg. 2017;102(9):26-35.
  7. MacDonald C. Understanding participatory action research: a qualitative research methodology option. The Canadian Journal of Action Research. 2012;13(2):34-50.
  8. Attwood H. An overview of issues around the use of participatory approaches by post-graduate students. In: IDS, Participatory Research, IDS PRATopic Pack (February, 1997). Brighton: IDS, University of Sussex; 1997:2.
  9. Selenger D. Participatory action research and social change. New York: Cornell University; 1997.
  10. Curran GM, Bauer M, Mittman B, Pyne JM, Stetler C. Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care. 2012;50(3):217-226. doi:10.1097/MLR.0b013e3182408812
  11. Proctor EK, Powell BJ, McMillen JC. Implementation strategies: recommendations for specifying and reporting. Implement Sci. 2013;8:139. doi:10.1186/1748-5908-8-139
  12. Saluja S, Silverstein A, Mukhopadhyay S, et al. Using the Consolidated Framework for Implementation Research to implement and evaluate national surgical planning. BMJ Glob Health. 2017;2(2):e000269. doi:10.1136/bmjgh-2016-000269
  13. Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50. doi:10.1186/1748-5908-4-50
  14. Stokols D, Hall KL, Taylor BK, Moser RP. The science of team science: overview of the field and introduction to the supplement. Am J Prev Med. 2008;35(2 Suppl):S77-89. doi:10.1016/j.amepre.2008.05.002
  15. Global Surgery Student Alliance website.  Accessed June 4, 2018.
  16. International Student Surgical Network website.  accessed June 17, 2018.
Volume 7, Issue 12
December 2018
Pages 1151-1154
  • Receive Date: 09 July 2018
  • Revise Date: 29 August 2018
  • Accept Date: 02 September 2018
  • First Publish Date: 01 December 2018