Beyond Policy: Strengthening District Level Access to Surgery Is Critical to Achieving Surgical Equity in Universal Health Coverage; Comment on “Improving Access to Surgery Through Surgical Team Mentoring – Policy Lessons From Group Model Building With Local Stakeholders in Malawi”

Document Type : Commentary

Author

1 The Global Alliance for Surgical, Obstetric, Trauma, and Anesthesia Care (G4 Alliance), Chicago, IL, USA

2 Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX, USA

Abstract

District level access to surgical care has been identified as the rate limiting step to increasing access to the bottom billion and relies on a complex interplay of patient-related and system-based factors that underlie the provision of quality surgical care at point of care. Surgical mentoring via visiting teams, use of current proprietary technologies to enhance communication, establishment of a national surgical coordinator and multi-stakeholder engagement with creative cost-sharing have all demonstrated promising results. Regardless of strategic implementation frameworks, system-based thinking coupled with implementation science with practical solutions will be necessary to inform stakeholders on the best way forward in their respective geographic field of work charting a path towards surgical equity in universal health coverage (UHC).

Keywords


  1. Broekhuizen H, Ifeanyichi M, Mwapasa G, et al. Improving access to surgery through surgical team mentoring - policy lessons from group model building with local stakeholders in Malawi. Int J Health Policy Manag. 2022;11(9):1744-1755. doi:34172/ijhpm.2021.78
  2. Bendix PG, Anderson JE, Rose JA, Noormahomed EV, Bickler SW. Improving surgical systems in low- and middle-income countries: an inclusive framework for monitoring and evaluation. Int Health. 2015;7(6):380-383. doi:1093/inthealth/ihv054
  3. Madhuri V, Stewart RJ, Lakhoo K. Training of children’s surgical teams at district level in low- and middle-income countries (LMIC): from concept to reality—a south to south initiative. Int J Surg Glob Health. 2019;2(3):e08. doi:1097/gh9.0000000000000008
  4. Henry JA, Orgoi S, Govind S, Price RR, Lundeg G, Kehrer B. Strengthening surgical services at the soum (first-referral) hospital: the WHO emergency and essential surgical care (EESC) program in Mongolia. World J Surg. 2012;36(10):2359-2370. doi:1007/s00268-012-1668-z
  5. Henry JA. World Health Assembly Side event on Achieving Surgical Excellence through Evidence-Based Quality Improvement Initiatives in LMICs: Strategies for Scaling Up Access, Quality, and Safety in Surgical, Obstetric, Trauma, and Anesthesia Care. Geneva: G4 Alliance; 2022:2.
  6. Bust L, Chu K. Improving district hospital surgical capacity in resource limited settings: challenges and lessons from South Africa: Comment on "Improving access to surgery through surgical team mentoring - policy lessons from group model building with local stakeholders in Malawi". Int J Health Policy Manag. 2022;11(10):2361-2364. doi:34172/ijhpm.2022.6937
  7. Pittalis C, Brugha R, Crispino G, et al. Evaluation of a surgical supervision model in three African countries-protocol for a prospective mixed-methods controlled pilot trial. Pilot Feasibility Stud. 2019;5:25. doi:1186/s40814-019-0409-6
  8. Henry JA, Volk AS, Kariuki SK, et al. Ending neglected surgical diseases (NSDs): definitions, strategies, and goals for the next decade. Int J Health Policy Manag. 2022;11(9):1608-1615. doi:34172/ijhpm.2020.140
  9. Ikegami N. Fee-for-service payment - an evil practice that must be stamped out? Int J Health Policy Manag. 2015;4(2):57-59. doi:15171/ijhpm.2015.26
  10. Henry JA. The Right to Heal:Eradicating Neglected Surgical Diseases-Sharing the Progress in Meru County, Kenya. Paper presented at: Orlando, Florida: Academic Surgical Congress; 2020.
  11. World Health Organization (WHO). Thirteenth General Programme of Work 2019-2023. WHO; 2019. https://apps.who.int/iris/bitstream/handle/10665/324775/WHO-PRP-18.1-eng.pdf. Accessed July 31, 2022.
  12. World Health Organization (WHO). Strengthening Emergency and Essential Surgical Care and Anaesthesia as a Component of Universal Health Coverage. WHO; 2015.

Articles in Press, Corrected Proof
Available Online from 10 September 2023
  • Receive Date: 02 August 2022
  • Revise Date: 05 September 2023
  • Accept Date: 09 September 2023
  • First Publish Date: 10 September 2023