Universal Access to Surgical Care and Sustainable Development in Sub-Saharan Africa: A Case for Surgical Systems Research; Comment on “Global Surgery – Informing National Strategies for Scaling Up Surgery in Sub-Saharan Africa”

Document Type : Commentary


1 Republic of Zambia, Ministry of Foreign Affairs, Lusaka, Zambia

2 School of Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa


National level experiences, lessons learnt from the Millennium Development Goal (MDG) era coupled with the academic evidence and proposals generated by the Lancet Commission on Global Surgery (LCoGS) together with the economic arguments and recommendations from the World Bank Group’s “Essential Surgery” Disease Control Priorities (DCP3) publication, provided the impetus for political commitments to improve surgical care capacity at the primary level of the healthcare system in low- and middle-income countries (LMICs) as part of their drive towards universal health coverage (UHC) in the form of World Health Organization (WHO) Resolution A68.15. This global commitment from governments must be followed up with development of a Global Action Plan and a global coordination mechanism supported by regional implementation frameworks on the part of the WHO in order for the organisation to better coordinate all stakeholders and sustain the technical support needed to develop and implement national surgical health policy in the form of National Surgical Obstetric and Anaesthesia Plans (NSOAPs). As expounded by Gajewski et al, data and research output on surgical care is essential to informing policy development and programme implementation. This area still remains a challenge in sub-Saharan Africa (SSA) but it is envisaged that countries will include this key component in their ongoing national surgical healthcare policy development and programme implementation. In the Zambian case study, research in the area of Global Surgery investment-the surgical workforce scale-up is used to demonstrate the important role of implementation research in the development and implementation of the Zambian NSOAP as well as the need for international collaborations to this end. Scale-up reviews informed by implementation research to evaluate progress on the commitments contained in Resolution A68.15 and Decision A70.22 are essential to sustain the momentum and to help maintain focus on the gaps in all countries. There are opportunities for non-state actors especially local sub-regional academic institutions, non-governmental organizations (NGOs) and private sector to play a key role in surgical healthcare policy development and implementation research. Collection of and better information management of standardised surgical care indicators is essential for such research, for bi-annual WHO progress reporting and for demonstration of impact to justify and encourage further investments in surgical care.


Main Subjects

  1. United Nations Economic and Social Council (ECOSOC). Breaking the Silos: Cross-sectoral partnerships for advancing the Sustainable Development Goals (SDGs). https://www.un.org/ecosoc/sites/www.un.org.ecosoc/files/files/en/2016doc/partnership-forum-issue-note1.pdf. Accessed August 23, 2018.
  2. Hazlewood P,  Bouyé M. Sustainable Development Goals: Setting a New Course for People and Planet. http://www.wri.org/blog/2015/09/sustainable-development-goals-setting-new-course-people-and-planet. Accessed August 23, 2018.
  3. World Health Organisation. Health in the Sustainable Development Goals. http://www.searo.who.int/entity/health_situation_trends/health_in_sustainable_devlop_goals.pdf. Accessed August 23, 2018.
  4. World Health Organisation. WHO's Framework of Engagement with Non-State Actors (FENSA).http://origin.who.int/about/collaborations/non-state-actors/A69_R10-FENSA-en.pdf. Accessed August 23, 2018.
  5. Price R, Makasa E, Hollands M. World Health Assembly Resolution WHA68.15: "Strengthening Emergency and Essential Surgical Care and Anesthesia as a Component of Universal Health Coverage"—Addressing the Public Health Gaps Arising from Lack of Safe, Affordable and Accessible Surgical and Anesthetic Services. World J Surg. 2015 Sep;39(9):2115-2125. doi:10.1007/s00268-015-3153-y
  6. The World Health Organisation. Seventieth World Health Assembly Decision WHA70(22): Progress in the implementation of the 2030 Agenda for Sustainable Development. http://apps.who.int/gb/ebwha/pdf_files/WHA70/A70(22)-en.pdf. Accessed July 5, 2018.
  7. The World Bank Group. Disease Specific Priorities: Essential Surgery. http://siteresources.worldbank.org/EXTWBP/Resources/EssentialSurgery.htm. Accessed August 23, 2018.
  8. 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
  9. Centre for Global Health Delivery-Dubai, Harvard Medical School. Policy Brief. National Surgical Obstetrics and anaesthesia Planning: Process and Consensus Recommendations. https://ghd-dubai.hms.harvard.edu/files/ghd_dubai/files/2018-dubai_nsoap_policy_brief.pdf?m=1525866968 . Accessed August 23, 2018.
  10. 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.
  11. Republic of Zambia Ministry of Health. National Surgical, Obstetric, And Anaesthesia Strategic Plan (NSOASP) Year 2017-2021. http://www.cosecsa.org/sites/default/files/NSOAP_May%202017.pdf. Accessed August 23, 2018.
  12. Centers for Disease Control and Prevention. Saving Mothers, Giving Life: Emergency Obstetric and Newborn Care Access and Availability, Phase 1 Monitoring and Evaluation Report. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2014
  13. Bowman KG, Jovic G, Rangel S, Berry WR, Gawande AA. Pediatric emergency and essential surgical care in Zambian hospitals: a nationwide study. J Pediatr Surg. 2013;48(6):1363-1370. doi:10.1016/j.jpedsurg.2013.03.045
  14. Esquivel MM, Uribe-Leitz T, Makasa E, et al. Mapping disparities in access to safe, timely, and essential surgical care in Zambia. JAMA Surg. 2016;151(11):1064-1069. doi:10.1001/jamasurg.2016.2303
  15. Bowman K. Research in global surgery: what is true science? Surgery. 2013;154(3):646-647. doi:10.1016/j.surg.2013.06.008
  16. Malakata M. Surge in number of mobile internet users in Zambia. TWeb Africa website. http://www.itwebafrica.com/mobilex/322-zambia/242585-surge-in-mobile-internet-users-in-zambia. Accessed August 23, 2018.
Volume 8, Issue 1
January 2019
Pages 58-60
  • Receive Date: 05 July 2018
  • Revise Date: 23 August 2018
  • Accept Date: 27 October 2018
  • First Publish Date: 01 January 2019