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World Journal of Surgery
Published in: World Journal of Surgery 4/2015

01-04-2015 | Original Scientific Report

Essential Surgery: The Way Forward

Authors: Jaymie Ang Henry, Chris Bem, Caris Grimes, Eric Borgstein, Nyengo Mkandawire, William E. G. Thomas, S. William A. Gunn, Robert H. S. Lane, Michael H. Cotton

Published in: World Journal of Surgery | Issue 4/2015

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Abstract

Introduction

Very little surgical care is performed in low- and middle-income countries (LMICs). An estimated two billion people in the world have no access to essential surgical care, and non-surgeons perform much of the surgery in remote and rural areas. Surgical care is as yet not recognized as an integral aspect of primary health care despite its self-demonstrated cost-effectiveness. We aimed to define the parameters of a public health approach to provide surgical care to areas in most need.

Methods

Consensus meetings were held, field experience was collected via targeted interviews, and a literature review on the current state of essential surgical care provision in Sub-Saharan Africa (SSA) was conducted. Comparisons were made across international recommendations for essential surgical interventions and a consensus-driven list was drawn up according to their relative simplicity, resource requirement, and capacity to provide the highest impact in terms of averted mortality or disability.

Results

Essential Surgery consists of basic, low-cost surgical interventions, which save lives and prevent life-long disability or life-threatening complications and may be offered in any district hospital. Fifteen essential surgical interventions were deduced from various recommendations from international surgical bodies. Training in the realm of Essential Surgery is narrow and strict enough to be possible for non-physician clinicians (NPCs). This cadre is already active in many SSA countries in providing the bulk of surgical care.

Conclusion

A basic package of essential surgical care interventions is imperative to provide structure for scaling up training and building essential health services in remote and rural areas of LMICs. NPCs, a health cadre predominant in SSA, require training, mentoring, and monitoring. The cost of such training is vastly more efficient than the expensive training of a few polyvalent or specialist surgeons, who will not be sufficient in numbers within the next few generations. Moreover, these practitioners are used to working in the districts and are much less prone to gravitate elsewhere. The use of these NPCs performing “Essential Surgery” is a feasible route to deal with the almost total lack of primary surgical care in LMICs.
Footnotes
1
ICES consists of a group of surgeons, international leaders, public health specialists, and educators who aim to promote the effective provision of safe, essential low-cost surgical care to deal with the significant burden of surgical disease in LMICs. The group strives to 1. Advocate and promote the need for essential surgery. 2. Identify essential surgical procedures that are cost-effective and indispensible to a community. 3. Promote and support education and training programs. 4. Identify local and regional training centers to coordinate essential surgical care delivery. 5. Support local surgical societies in training activities. 6. Encourage established surgical societies to include surgical care to poorly served communities within their mission statement. 7. Facilitate international cooperation for educational efforts, research, and advocacy in support of the essential, safe surgical for all initiative. 8. Work across health care networks to recognize essential surgery as a significant component of Public Health.
 
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Metadata
Title
Essential Surgery: The Way Forward
Authors
Jaymie Ang Henry
Chris Bem
Caris Grimes
Eric Borgstein
Nyengo Mkandawire
William E. G. Thomas
S. William A. Gunn
Robert H. S. Lane
Michael H. Cotton
Publication date
01-04-2015
Publisher
Springer US
Published in
World Journal of Surgery / Issue 4/2015
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-014-2937-9

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