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Published in: World Journal of Surgery 3/2019

01-03-2019 | Surgery in Low and Middle Income Countries

Strengthening Surgery Strengthens Health Systems: A New Paradigm and Potential Pathway for Horizontal Development in Low- and Middle-Income Countries

Authors: S. Ariane Christie, Benedict C. Nwomeh, Sanjay Krishnaswami, George P. Yang, Ai-Xuan L. Holterman, Anthony Charles, Sudha Jayaraman, Randeep S. Jawa, Jennifer Rickard, Mamta Swaroop, Sifri C. Ziad, Georges Alain Etoundi Mballa, Martin Ekeke Monono, Alain Chichom Mefire, Catherine Juillard

Published in: World Journal of Surgery | Issue 3/2019

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Abstract

Global health is transitioning toward a focus on building strong and sustainable health systems in developing countries; however, resources, funding, and agendas continue to concentrate on “vertical” (disease-based) improvements in care. Surgical care in low- and middle-income countries (LMICs) requires the development of health systems infrastructure and can be considered an indicator of overall system readiness. Improving surgical care provides a scalable gateway to strengthen health systems in multiple domains. In this position paper by the Society of University Surgeons’ Committee on Global Academic Surgery, we propose that health systems development appropriately falls within the purview of the academic surgeon. Partnerships between academic surgical institutions and societies from high-income and resource-constrained settings are needed to strengthen advocacy and funding efforts and support development of training and research in LMICs.
Literature
1.
go back to reference Dieleman JL, Schneider MT, Haakenstad A, Singh L, Sadat N, Birger M, Reynolds A, Templin T, Hamavid H, Chapin A, Murray CJ (2016) Development assistance for health: past trends, associations, and the future of international financial flows for health. Lancet 387(10037):2536–2544PubMedCrossRef Dieleman JL, Schneider MT, Haakenstad A, Singh L, Sadat N, Birger M, Reynolds A, Templin T, Hamavid H, Chapin A, Murray CJ (2016) Development assistance for health: past trends, associations, and the future of international financial flows for health. Lancet 387(10037):2536–2544PubMedCrossRef
2.
go back to reference Mortality GBD, Causes of Death C (2015) Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 385(9963):117–171CrossRef Mortality GBD, Causes of Death C (2015) Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 385(9963):117–171CrossRef
3.
go back to reference Beaglehole R, Bonita R, Horton R, Adams C, Alleyne G, Asaria P, Baugh V, Bekedam H, Billo N, Casswell S, Cecchini M (2011) Priority actions for the non-communicable disease crisis. Lancet 377(9775):1438–1447PubMedCrossRef Beaglehole R, Bonita R, Horton R, Adams C, Alleyne G, Asaria P, Baugh V, Bekedam H, Billo N, Casswell S, Cecchini M (2011) Priority actions for the non-communicable disease crisis. Lancet 377(9775):1438–1447PubMedCrossRef
4.
go back to reference Dalal S, Beunza JJ, Volmink J, Adebamowo C, Bajunirwe F, Njelekela M, Mozaffarian D, Fawzi W, Willett W, Adami HO, Holmes MD (2011) Non-communicable diseases in sub-Saharan Africa: what we know now. Int J Epidemiol 40(4):885–901PubMedCrossRef Dalal S, Beunza JJ, Volmink J, Adebamowo C, Bajunirwe F, Njelekela M, Mozaffarian D, Fawzi W, Willett W, Adami HO, Holmes MD (2011) Non-communicable diseases in sub-Saharan Africa: what we know now. Int J Epidemiol 40(4):885–901PubMedCrossRef
5.
go back to reference Chao TE, Sharma K, Mandigo M, Hagander L, Resch SC, Weiser TG, Meara JG (2014) Cost-effectiveness of surgery and its policy implications for global health: a systematic review and analysis. Lancet Glob Health 2(6):e334–e345PubMedCrossRef Chao TE, Sharma K, Mandigo M, Hagander L, Resch SC, Weiser TG, Meara JG (2014) Cost-effectiveness of surgery and its policy implications for global health: a systematic review and analysis. Lancet Glob Health 2(6):e334–e345PubMedCrossRef
7.
go back to reference Mock CN, Donkor P, Gawande A et al (2015) Essential surgery: key messages from Disease Control Priorities. Lancet 385(9983):2209–2219PubMedCrossRef Mock CN, Donkor P, Gawande A et al (2015) Essential surgery: key messages from Disease Control Priorities. Lancet 385(9983):2209–2219PubMedCrossRef
8.
go back to reference Organization WH (2011) Global status report on noncommunicable diseases 2010. World Health Organzation, Geneva Organization WH (2011) Global status report on noncommunicable diseases 2010. World Health Organzation, Geneva
9.
go back to reference Price R, Makasa E, Hollands M (2015) 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 39(9):2115–2125. https://doi.org/10.1007/s00268-015-3153-y PubMedCrossRef Price R, Makasa E, Hollands M (2015) 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 39(9):2115–2125. https://​doi.​org/​10.​1007/​s00268-015-3153-y PubMedCrossRef
10.
go back to reference Dieleman JL, Graves CM, Templin T, Johnson E, Baral R, Leach-Kemon K, Haakenstad AM, Murray CJ (2014) Global health development assistance remained steady in 2013 but did not align with recipients’ disease burden. Health Aff 33(5):878–886CrossRef Dieleman JL, Graves CM, Templin T, Johnson E, Baral R, Leach-Kemon K, Haakenstad AM, Murray CJ (2014) Global health development assistance remained steady in 2013 but did not align with recipients’ disease burden. Health Aff 33(5):878–886CrossRef
11.
12.
go back to reference Benton A (2015) HIV exceptionalism: development through disease in Sierra Leone. University of Minnesota Press, MinneapolisCrossRef Benton A (2015) HIV exceptionalism: development through disease in Sierra Leone. University of Minnesota Press, MinneapolisCrossRef
13.
go back to reference Good MJ, Mwaikambo E, Amayo E et al (1999) Clinical realities and moral dilemmas: contrasting perspectives from academic medicine in Kenya, Tanzania, and America. Daedalus 128(4):167–196PubMed Good MJ, Mwaikambo E, Amayo E et al (1999) Clinical realities and moral dilemmas: contrasting perspectives from academic medicine in Kenya, Tanzania, and America. Daedalus 128(4):167–196PubMed
14.
go back to reference Marie-Paule Kieny DBE, Kadandale Sowmya (2014) Health-system resilience: reflections on the Ebola crises in western Africa. Bull World Health Organ 92:850PubMedPubMedCentralCrossRef Marie-Paule Kieny DBE, Kadandale Sowmya (2014) Health-system resilience: reflections on the Ebola crises in western Africa. Bull World Health Organ 92:850PubMedPubMedCentralCrossRef
15.
go back to reference Ohuabunwo C, Ameh C, Oduyebo O et al (2016) Clinical profile and containment of the Ebola virus disease outbreak in two large West African cities, Nigeria, July–September 2014. Int J Infect Dis 53:23–29PubMedCrossRef Ohuabunwo C, Ameh C, Oduyebo O et al (2016) Clinical profile and containment of the Ebola virus disease outbreak in two large West African cities, Nigeria, July–September 2014. Int J Infect Dis 53:23–29PubMedCrossRef
17.
go back to reference Farmer P, Frenk J, Knaul FM et al (2010) Expansion of cancer care and control in countries of low and middle income: a call to action. Lancet 376(9747):1186–1193PubMedCrossRef Farmer P, Frenk J, Knaul FM et al (2010) Expansion of cancer care and control in countries of low and middle income: a call to action. Lancet 376(9747):1186–1193PubMedCrossRef
18.
go back to reference McQueen KA, Ozgediz D, Riviello R et al (2010) Essential surgery: integral to the right to health. Health Hum Rights 12(1):137–152PubMed McQueen KA, Ozgediz D, Riviello R et al (2010) Essential surgery: integral to the right to health. Health Hum Rights 12(1):137–152PubMed
19.
go back to reference Ozgediz D, Jamison D, Cherian M et al (2008) The burden of surgical conditions and access to surgical care in low- and middle-income countries. Bull World Health Organ 86(8):646–647PubMedPubMedCentralCrossRef Ozgediz D, Jamison D, Cherian M et al (2008) The burden of surgical conditions and access to surgical care in low- and middle-income countries. Bull World Health Organ 86(8):646–647PubMedPubMedCentralCrossRef
20.
go back to reference Waage J, Banerji R, Campbell O et al (2010) The millennium development goals: a cross-sectoral analysis and principles for goal setting after 2015 Lancet and London International Development Centre Commission. Lancet 376(9745):991–1023PubMedCrossRef Waage J, Banerji R, Campbell O et al (2010) The millennium development goals: a cross-sectoral analysis and principles for goal setting after 2015 Lancet and London International Development Centre Commission. Lancet 376(9745):991–1023PubMedCrossRef
21.
22.
go back to reference DeVries CR, Rosenberg JS (2016) Global surgical ecosystems: a need for systems strengthening. Ann Glob Health 82:605–613PubMedCrossRef DeVries CR, Rosenberg JS (2016) Global surgical ecosystems: a need for systems strengthening. Ann Glob Health 82:605–613PubMedCrossRef
23.
go back to reference Kushner AL, Cherian MN, Noel L et al (2010) Addressing the millennium development goals from a surgical perspective: essential surgery and anesthesia in 8 low- and middle-income countries. Arch Surg 145(2):154–159PubMedCrossRef Kushner AL, Cherian MN, Noel L et al (2010) Addressing the millennium development goals from a surgical perspective: essential surgery and anesthesia in 8 low- and middle-income countries. Arch Surg 145(2):154–159PubMedCrossRef
24.
go back to reference Petroze RT, Nzayisenga A, Rusanganwa V, Ntakiyiruta G, Calland JF (2012) Comprehensive national analysis of emergency and essential surgical capacity in Rwanda. Br J Surg 99(3):436–443PubMedCrossRef Petroze RT, Nzayisenga A, Rusanganwa V, Ntakiyiruta G, Calland JF (2012) Comprehensive national analysis of emergency and essential surgical capacity in Rwanda. Br J Surg 99(3):436–443PubMedCrossRef
25.
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(2):122–127 (discussion 128) PubMedCrossRef Kingham TP, Kamara TB, Cherian MN et al (2009) Quantifying surgical capacity in Sierra Leone: a guide for improving surgical care. Arch Surg 144(2):122–127 (discussion 128) PubMedCrossRef
28.
go back to reference Iddriss A, Shivute N, Bickler S, Cole-Ceesay R, Jargo B, Abdullah F, Cherian M (2011) Emergency, anaesthetic and essential surgical capacity in the Gambia. Bull World Health Organ 89:565–572PubMedPubMedCentralCrossRef Iddriss A, Shivute N, Bickler S, Cole-Ceesay R, Jargo B, Abdullah F, Cherian M (2011) Emergency, anaesthetic and essential surgical capacity in the Gambia. Bull World Health Organ 89:565–572PubMedPubMedCentralCrossRef
29.
go back to reference LeBrun DG, Chackungal S, Chao TE, Knowlton LM, Linden AF, Notrica MR, Solis CV, McQueen KK (2014) Prioritizing essential surgery and safe anesthesia for the post-2015 development agenda: operative capacities of 78 district hospitals in 7 low-and middle-income countries. Surgery 155(3):365–373PubMedCrossRef LeBrun DG, Chackungal S, Chao TE, Knowlton LM, Linden AF, Notrica MR, Solis CV, McQueen KK (2014) Prioritizing essential surgery and safe anesthesia for the post-2015 development agenda: operative capacities of 78 district hospitals in 7 low-and middle-income countries. Surgery 155(3):365–373PubMedCrossRef
31.
32.
go back to reference Wong EG, Gupta S, Deckelbaum DL, Razek T, Kushner AL (2015) Prioritizing injury care: a review of trauma capacity in low and middle-income countries. J Surg Res 193(1):217–222PubMedCrossRef Wong EG, Gupta S, Deckelbaum DL, Razek T, Kushner AL (2015) Prioritizing injury care: a review of trauma capacity in low and middle-income countries. J Surg Res 193(1):217–222PubMedCrossRef
33.
go back to reference Blair KJ, Paladino L, Shaw PL, Shapiro MB, Nwomeh BC, Swaroop M (2017) Surgical and trauma care in low-and middle-income countries: a review of capacity assessments. J Surg Res 210:139–151PubMedCrossRef Blair KJ, Paladino L, Shaw PL, Shapiro MB, Nwomeh BC, Swaroop M (2017) Surgical and trauma care in low-and middle-income countries: a review of capacity assessments. J Surg Res 210:139–151PubMedCrossRef
34.
go back to reference Codman NDEA (2002) Heroes and martyrs of quality and safety: Earnest Armory Codman MD. BMJ Qual Saf Health Care 11:104–105CrossRef Codman NDEA (2002) Heroes and martyrs of quality and safety: Earnest Armory Codman MD. BMJ Qual Saf Health Care 11:104–105CrossRef
35.
go back to reference American College of Surgeons Committee on Trauma (1976) Optimal hospital resources for care of the seriously injured. Bull Am Coll Surg 61(9):15–22 American College of Surgeons Committee on Trauma (1976) Optimal hospital resources for care of the seriously injured. Bull Am Coll Surg 61(9):15–22
36.
go back to reference Shackford SR, Hollingworth-Fridlund P, Cooper GF et al (1986) The effect of regionalization upon the quality of trauma care as assessed by concurrent audit before and after institution of a trauma system: a preliminary report. J Trauma 26(9):812–820PubMedCrossRef Shackford SR, Hollingworth-Fridlund P, Cooper GF et al (1986) The effect of regionalization upon the quality of trauma care as assessed by concurrent audit before and after institution of a trauma system: a preliminary report. J Trauma 26(9):812–820PubMedCrossRef
37.
go back to reference Nathens AB, Jurkovich GJ, Rivara FP et al (2000) Effectiveness of state trauma systems in reducing injury-related mortality: a national evaluation. J Trauma 48(1):25–30 (discussion 30–21) PubMedCrossRef Nathens AB, Jurkovich GJ, Rivara FP et al (2000) Effectiveness of state trauma systems in reducing injury-related mortality: a national evaluation. J Trauma 48(1):25–30 (discussion 30–21) PubMedCrossRef
38.
go back to reference Shafi S, Nathens AB, Elliott AC et al (2006) Effect of trauma systems on motor vehicle occupant mortality: a comparison between states with and without a formal system. J Trauma 16(6):1374–1378 (discussion 1378–1379) CrossRef Shafi S, Nathens AB, Elliott AC et al (2006) Effect of trauma systems on motor vehicle occupant mortality: a comparison between states with and without a formal system. J Trauma 16(6):1374–1378 (discussion 1378–1379) CrossRef
39.
go back to reference Cayten CG, Quervalu I, Agarwal N (1999) Fatality analysis reporting system demonstrates association between trauma system initiatives and decreasing death rates. J Trauma 46(5):751–755 (discussion 755–756) PubMedCrossRef Cayten CG, Quervalu I, Agarwal N (1999) Fatality analysis reporting system demonstrates association between trauma system initiatives and decreasing death rates. J Trauma 46(5):751–755 (discussion 755–756) PubMedCrossRef
40.
go back to reference Jurkovich GJ, Mock C (1999) Systematic review of trauma system effectiveness based on registry comparisons. J Trauma 47(3 Suppl):S46–S55PubMedCrossRef Jurkovich GJ, Mock C (1999) Systematic review of trauma system effectiveness based on registry comparisons. J Trauma 47(3 Suppl):S46–S55PubMedCrossRef
41.
go back to reference Shackford SR, Hollingsworth-Fridlund P, McArdle M et al (1987) Assuring quality in a trauma system—the Medical Audit Committee: composition, cost, and results. J Trauma 27(8):866–875PubMedCrossRef Shackford SR, Hollingsworth-Fridlund P, McArdle M et al (1987) Assuring quality in a trauma system—the Medical Audit Committee: composition, cost, and results. J Trauma 27(8):866–875PubMedCrossRef
42.
go back to reference O’Keefe GE, Maier RV, Diehr P et al (1997) The complications of trauma and their associated costs in a level I trauma center. Arch Surg 132(8):920–924 (discussion 925) PubMedCrossRef O’Keefe GE, Maier RV, Diehr P et al (1997) The complications of trauma and their associated costs in a level I trauma center. Arch Surg 132(8):920–924 (discussion 925) PubMedCrossRef
43.
go back to reference Shafi S, Nathens AB, Cryer HG et al (2009) The trauma quality improvement program of the American College of Surgeons Committee on Trauma. J Am Coll Surg 209(4):521–530 e521 Shafi S, Nathens AB, Cryer HG et al (2009) The trauma quality improvement program of the American College of Surgeons Committee on Trauma. J Am Coll Surg 209(4):521–530 e521
44.
go back to reference Haynes AB, Weiser TG, Berry WR et al (2009) A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 360(5):491–499PubMedCrossRef Haynes AB, Weiser TG, Berry WR et al (2009) A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 360(5):491–499PubMedCrossRef
45.
go back to reference Conley DM, Singer SJ, Edmondson L et al (2011) Effective surgical safety checklist implementation. J Am Coll Surg 212(5):873–879PubMedCrossRef Conley DM, Singer SJ, Edmondson L et al (2011) Effective surgical safety checklist implementation. J Am Coll Surg 212(5):873–879PubMedCrossRef
46.
go back to reference Stulberg JJ, Delaney CP, Neuhauser DV et al (2010) Adherence to surgical care improvement project measures and the association with postoperative infections. JAMA 303(24):2479–2485PubMedCrossRef Stulberg JJ, Delaney CP, Neuhauser DV et al (2010) Adherence to surgical care improvement project measures and the association with postoperative infections. JAMA 303(24):2479–2485PubMedCrossRef
Metadata
Title
Strengthening Surgery Strengthens Health Systems: A New Paradigm and Potential Pathway for Horizontal Development in Low- and Middle-Income Countries
Authors
S. Ariane Christie
Benedict C. Nwomeh
Sanjay Krishnaswami
George P. Yang
Ai-Xuan L. Holterman
Anthony Charles
Sudha Jayaraman
Randeep S. Jawa
Jennifer Rickard
Mamta Swaroop
Sifri C. Ziad
Georges Alain Etoundi Mballa
Martin Ekeke Monono
Alain Chichom Mefire
Catherine Juillard
Publication date
01-03-2019
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 3/2019
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-018-4854-9

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