Skip to main content
Top
Published in: World Journal of Surgery 9/2015

01-09-2015 | Surgical Symposium Contribution

Surgical Care and Health Systems

Authors: David A. Spiegel, Mohit Misra, Peter Bendix, Lars Hagander, Stephen W. Bickler, C. Omar Saleh, Martin Ekeke-Monono, Dinah Baah-Odoom, Amber Caldwell, Beryl Irons, Sheik Amir, Robert Taylor, Maya Layne, Helena Hailu, Syed Mohammad Awais, Raymond R. Price, Sarah Crockett, Monir Islam, Health Systems Strengthening Working Group of the Global Initiative for Emergency and Essential Surgical Care

Published in: World Journal of Surgery | Issue 9/2015

Login to get access

Abstract

Background

While surgical care impacts a wide variety of diseases and conditions with non-operative and operative services, both preventive and curative, there has been little discussion concerning how surgery might be integrated within the health system of a low and middle-income country (LMIC), nor how strengthening surgical services may improve health systems and population health.

Methods

We reviewed reports from several meetings of the working group on health systems strengthening of the Global Initiative for Emergency and Essential Surgical Care, and also performed a review of the literature including the search terms “surgery,” “health system,” “developing country,” “health systems strengthening,” “health information system,” “financing,” “governance,” and “integration.”

Results

The literature search revealed no reports which focused on the integration of surgical services within a health system or as a component of health system strengthening. A conceptual model of how surgical care might be integrated within a health system is proposed, based on the discussions of our working group, combined with sources from the medical literature, and utilizing the World Health Organization’s conceptual model of a health system.

Conclusions

Strengthening the delivery of surgical services in LMICs will require inputs at multiple levels within a health system, and this effort will require the coalescence of committed individuals and organizations, supported by civil society.
Literature
1.
go back to reference World Health Report (2000) Health systems: improving performance. World Health Organization, Geneva World Health Report (2000) Health systems: improving performance. World Health Organization, Geneva
2.
go back to reference WHO (2007) Everyobody’s business: strengthening health systems to improve health outcomes: WHO’s framework for action. World Health Organization, Geneva WHO (2007) Everyobody’s business: strengthening health systems to improve health outcomes: WHO’s framework for action. World Health Organization, Geneva
4.
go back to reference World Health Report (2008) Primary healthcare, Now more than ever. World Health Organization, Geneva World Health Report (2008) Primary healthcare, Now more than ever. World Health Organization, Geneva
5.
go back to reference Shakarishvili G, Lansang MA, Mitta V et al (2011) Health systems strengthening: a common classification and framework for investment analysis. Health Policy Plan 26:316–326PubMedCentralPubMedCrossRef Shakarishvili G, Lansang MA, Mitta V et al (2011) Health systems strengthening: a common classification and framework for investment analysis. Health Policy Plan 26:316–326PubMedCentralPubMedCrossRef
6.
go back to reference Shakarishvili G, Atun R, Berman P et al (2010) Converging health systems frameworks: towards a concepts-to-actions roadmap for health systems strengthening in low and middle income countries. Global Health Gov III(2):1–17 Shakarishvili G, Atun R, Berman P et al (2010) Converging health systems frameworks: towards a concepts-to-actions roadmap for health systems strengthening in low and middle income countries. Global Health Gov III(2):1–17
8.
go back to reference Hurst J (1991) Reforming health care in seven European nations. Health Aff 10:7–21CrossRef Hurst J (1991) Reforming health care in seven European nations. Health Aff 10:7–21CrossRef
9.
go back to reference Mills A, Rasheed F, Tollman S (2006) Strengthening health systems. In: Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, Jha P, Mills A, Musgrove P (eds) Disease control priorities in developing countries, 2nd edn. World Bank, Washington (DC) Mills A, Rasheed F, Tollman S (2006) Strengthening health systems. In: Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, Jha P, Mills A, Musgrove P (eds) Disease control priorities in developing countries, 2nd edn. World Bank, Washington (DC)
10.
go back to reference Evans RG. Incomplete vertical integration: The distinctive structure of the health care industry. (1981) In Health, Economics, and Health Economics, Ed. Van der Gaag J, Perlman M, Amsterdam, North Holland Evans RG. Incomplete vertical integration: The distinctive structure of the health care industry. (1981) In Health, Economics, and Health Economics, Ed. Van der Gaag J, Perlman M, Amsterdam, North Holland
11.
go back to reference Roberts M, Hsiao W, Berman P et al (2003) Getting health reform right: a guide to improving performance and equity. Oxford University Press, New York Roberts M, Hsiao W, Berman P et al (2003) Getting health reform right: a guide to improving performance and equity. Oxford University Press, New York
12.
go back to reference De Savigny D, Adam T (2009) Systems thinking for health system strengthening. Alliance for health policy and Systems Research, World Health Organization, Geneva De Savigny D, Adam T (2009) Systems thinking for health system strengthening. Alliance for health policy and Systems Research, World Health Organization, Geneva
13.
go back to reference Adam T, de Savigny D (2012) Systems thinking for strengthening health systems in LMICs: need for a paradigm shift. Health Policy Plan 27 Suppl 4:iv1-3 Adam T, de Savigny D (2012) Systems thinking for strengthening health systems in LMICs: need for a paradigm shift. Health Policy Plan 27 Suppl 4:iv1-3
14.
go back to reference Adam T, Hsu J, de Savigny D et al (2012) Evaluating health systems strengthening interventions in low-income and middle-income countries: are we asking the right questions? Health Policy Plan 27 Suppl 4:iv9-19 Adam T, Hsu J, de Savigny D et al (2012) Evaluating health systems strengthening interventions in low-income and middle-income countries: are we asking the right questions? Health Policy Plan 27 Suppl 4:iv9-19
15.
go back to reference Sundewall J, Swanson RC, Betigeri A, Sanders D et al (2011) Health-systems strengthening: current and future activities. Lancet 377:1222–1223PubMedCrossRef Sundewall J, Swanson RC, Betigeri A, Sanders D et al (2011) Health-systems strengthening: current and future activities. Lancet 377:1222–1223PubMedCrossRef
16.
17.
go back to reference Cavalli A, Bamba SI, Traore MN et al (2010) Interactions between Global Health Initiatives and country health systems: the case of a neglected tropical diseases control program in Mali. PLoS Negl Trop Dis 4:e798PubMedCentralPubMedCrossRef Cavalli A, Bamba SI, Traore MN et al (2010) Interactions between Global Health Initiatives and country health systems: the case of a neglected tropical diseases control program in Mali. PLoS Negl Trop Dis 4:e798PubMedCentralPubMedCrossRef
18.
go back to reference Samb B, Evans T, Dybul M et al (World Health Organization Maximizing Positive Synergies Collaborative Group) (2009) An assessment of interactions between global health initiatives and country health systems. Lancet 373:2137–2169CrossRef Samb B, Evans T, Dybul M et al (World Health Organization Maximizing Positive Synergies Collaborative Group) (2009) An assessment of interactions between global health initiatives and country health systems. Lancet 373:2137–2169CrossRef
19.
go back to reference Pfeiffer J, Johnson W, Fort M et al (2008) Strengthening health systems in poor countries: a code of conduct for nongovernmental organizations. Am J Public Health 98:2134–2140PubMedCentralPubMedCrossRef Pfeiffer J, Johnson W, Fort M et al (2008) Strengthening health systems in poor countries: a code of conduct for nongovernmental organizations. Am J Public Health 98:2134–2140PubMedCentralPubMedCrossRef
20.
go back to reference Cohn J, Russell A, Baker B et al (2011) Using global health initiatives to strengthen health systems: a civil society perspective. Glob Public Health 6:687–702PubMedCrossRef Cohn J, Russell A, Baker B et al (2011) Using global health initiatives to strengthen health systems: a civil society perspective. Glob Public Health 6:687–702PubMedCrossRef
21.
go back to reference Patel PB, Hoyler M, Maine R et al (2012) An opportunity for diagonal development in global surgery: cleft lip and palate care in resource-limited settings. Plast Surg Int Article ID 892437 Patel PB, Hoyler M, Maine R et al (2012) An opportunity for diagonal development in global surgery: cleft lip and palate care in resource-limited settings. Plast Surg Int Article ID 892437
22.
go back to reference Marchal B, Cavalli A, Kegels G (2009) Global health actors claim to support health system strengthening: is this reality or rhetoric? PLoS Med 28;6(4):e1000059 Marchal B, Cavalli A, Kegels G (2009) Global health actors claim to support health system strengthening: is this reality or rhetoric? PLoS Med 28;6(4):e1000059
23.
go back to reference Swanson RC, Cattaneo A, Bradley E et al (2012) Rethinking health systems strengthening: key systems thinking tools and strategies for transformational change. Health Policy Plan 27 Suppl 4:iv54-61 Swanson RC, Cattaneo A, Bradley E et al (2012) Rethinking health systems strengthening: key systems thinking tools and strategies for transformational change. Health Policy Plan 27 Suppl 4:iv54-61
24.
go back to reference Swanson RC, Bongiovanni A, Bradley E, et al (2010) Toward a consensus on guiding principles for health systems strengthening. PLoS Med Swanson RC, Bongiovanni A, Bradley E, et al (2010) Toward a consensus on guiding principles for health systems strengthening. PLoS Med
27.
28.
32.
go back to reference Frenk J, Chen L, Bhutta ZA et al (2010) Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet 376:1923–1958PubMedCrossRef Frenk J, Chen L, Bhutta ZA et al (2010) Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet 376:1923–1958PubMedCrossRef
34.
go back to reference Cherian M, Choo S, Wilson I et al (2010) Building and retaining the neglected anaesthesia health workforce: is it crucial for health systems strengthening through primary health care? Bull World Health Organ 88:637–639PubMedCentralPubMedCrossRef Cherian M, Choo S, Wilson I et al (2010) Building and retaining the neglected anaesthesia health workforce: is it crucial for health systems strengthening through primary health care? Bull World Health Organ 88:637–639PubMedCentralPubMedCrossRef
35.
go back to reference Kruk ME, Pereira C, Vaz F et al (2007) Economic evaluation of surgically trained assistant medical officers in performing major obstetric surgery in Mozambique. BJOG 114:1253–1260PubMedCrossRef Kruk ME, Pereira C, Vaz F et al (2007) Economic evaluation of surgically trained assistant medical officers in performing major obstetric surgery in Mozambique. BJOG 114:1253–1260PubMedCrossRef
36.
go back to reference Mkandawire N, Ngulube C, Lavy C (2008) Orthopaedic clinical officer program in Malawi. A model for providing orthopaedic care. Clin Orthop Rel Res 466:2385–2391CrossRef Mkandawire N, Ngulube C, Lavy C (2008) Orthopaedic clinical officer program in Malawi. A model for providing orthopaedic care. Clin Orthop Rel Res 466:2385–2391CrossRef
37.
go back to reference Atiyeh BS, Gunn SW, Hayek SN (2010) Provision of essential surgery in remote and rural areas of developed as well as low and middle income countries. Int J Surg 8:581–585PubMedCrossRef Atiyeh BS, Gunn SW, Hayek SN (2010) Provision of essential surgery in remote and rural areas of developed as well as low and middle income countries. Int J Surg 8:581–585PubMedCrossRef
39.
go back to reference Choo S, Perry H, Hesse AA et al (2010) Assessment of capacity for surgery, obstetrics and anaesthesia in 17 Ghanaian hospitals using a WHO assessment tool. Trop Med Int Health 15:1109–1115PubMed Choo S, Perry H, Hesse AA et al (2010) Assessment of capacity for surgery, obstetrics and anaesthesia in 17 Ghanaian hospitals using a WHO assessment tool. Trop Med Int Health 15:1109–1115PubMed
42.
go back to reference Hsia RY, Mbembati NA, MacFarlane S et al (2012) Access to emergency and surgical care in sub-saharan africa: the infrastructure gap. Health Policy Plan 27:234–244PubMedCrossRef Hsia RY, Mbembati NA, MacFarlane S et al (2012) Access to emergency and surgical care in sub-saharan africa: the infrastructure gap. Health Policy Plan 27:234–244PubMedCrossRef
43.
44.
go back to reference Kingham TP, Kamara TB, Cherian MN et al (2009) Quantifying surgical capacity in Sierra Leone. A guide for improving surgical care. Arch Surg 144:122–127PubMedCrossRef Kingham TP, Kamara TB, Cherian MN et al (2009) Quantifying surgical capacity in Sierra Leone. A guide for improving surgical care. Arch Surg 144:122–127PubMedCrossRef
46.
go back to reference Kushner AL, Cherian MN, Noel LPJ et al (2010) Addressing the millennium development goals from a surgical perspective: deficiencies in the capacity to deliver safe surgery and anaesthesia in eight low and middle-income countries. Arch Surg 145:154–160PubMedCrossRef Kushner AL, Cherian MN, Noel LPJ et al (2010) Addressing the millennium development goals from a surgical perspective: deficiencies in the capacity to deliver safe surgery and anaesthesia in eight low and middle-income countries. Arch Surg 145:154–160PubMedCrossRef
48.
51.
go back to reference Penoyer T, Cohen H, Kibatala P et al (2012) Emergency and surgery services of primary hospitals in the United Republic of Tanzania. BMJ Open 2:e000369 Penoyer T, Cohen H, Kibatala P et al (2012) Emergency and surgery services of primary hospitals in the United Republic of Tanzania. BMJ Open 2:e000369
52.
go back to reference Petroze RT, Nzayisenga A, Rusanganwa V et al (2012) Comprehensive national analysis of emergency and essential surgical capacity in Rwanda. Br J Surg 99:436–443PubMedCrossRef Petroze RT, Nzayisenga A, Rusanganwa V et al (2012) Comprehensive national analysis of emergency and essential surgical capacity in Rwanda. Br J Surg 99:436–443PubMedCrossRef
53.
go back to reference Sherman LA, Clement PT, Cherian MN et al (2011) Implementing Liberia’s poverty reduction strategy. An assessment of emergency and essential surgical care. Arch Surg 146:35–39PubMedCrossRef Sherman LA, Clement PT, Cherian MN et al (2011) Implementing Liberia’s poverty reduction strategy. An assessment of emergency and essential surgical care. Arch Surg 146:35–39PubMedCrossRef
58.
go back to reference Islam M (2007) Health Systems Assessment Approach: A How-To Manual. Submitted to the U.S. Agency for International Development in collaboration with Health Systems 20/20, Partners for Health Reform plus, Quality Assurance Project, and Rational Pharmaceutical Management Plus. Management Sciences for Health, Arlington Islam M (2007) Health Systems Assessment Approach: A How-To Manual. Submitted to the U.S. Agency for International Development in collaboration with Health Systems 20/20, Partners for Health Reform plus, Quality Assurance Project, and Rational Pharmaceutical Management Plus. Management Sciences for Health, Arlington
60.
go back to reference Lagarde M, Palmer N (2011) The impact of user fees on access to health services in low- and middle-income countries. Cochrane Database Syst Rev 4:CD009094 Lagarde M, Palmer N (2011) The impact of user fees on access to health services in low- and middle-income countries. Cochrane Database Syst Rev 4:CD009094
Metadata
Title
Surgical Care and Health Systems
Authors
David A. Spiegel
Mohit Misra
Peter Bendix
Lars Hagander
Stephen W. Bickler
C. Omar Saleh
Martin Ekeke-Monono
Dinah Baah-Odoom
Amber Caldwell
Beryl Irons
Sheik Amir
Robert Taylor
Maya Layne
Helena Hailu
Syed Mohammad Awais
Raymond R. Price
Sarah Crockett
Monir Islam
Health Systems Strengthening Working Group of the Global Initiative for Emergency and Essential Surgical Care
Publication date
01-09-2015
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 9/2015
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-014-2928-x

Other articles of this Issue 9/2015

World Journal of Surgery 9/2015 Go to the issue