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World Journal of Surgery

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01-08-2020 | COVID-19 | Surgery in Low and Middle Income Countries

Exploring the Impact of COVID-19 on Progress Towards Achieving Global Surgery Goals

Authors: Dennis Mazingi, Sergio Navarro, Matthew C. Bobel, Andile Dube, Chenesa Mbanje, Chris Lavy

Published in: World Journal of Surgery | Issue 8/2020

Abstract

Introduction

In the 5 months since it began, the COVID-19 pandemic has placed extraordinary demands on health systems around the world including surgery. Competing health objectives and resource redeployment threaten to retard the scale-up of surgical services in low- and middle-income countries where access to safe, affordable and timely care is low. The key aspiration of the Lancet Commission on global surgery was promotion of resilience in surgical systems. The current pandemic provides an opportunity to stress-test those systems and identify fault-lines that may not be easily apparent outside of times of crisis.

Methods

We endeavoured to explore vulnerable points in surgical systems learning from the experience of past outbreaks, using examples from the current pandemic, and make recommendations for future health emergencies. The 6-component framework for surgical systems planning was used to categorise the effects of COVID-19 on surgical systems, with a particular focus on low- and middle-income countries. Key vulnerabilities were identified and recommendations were made for the current pandemic and for the future.

Results

Multiple stress points were identified throughout all of the 6 components of surgical systems. The impact is expected to be highest in the workforce, service delivery and infrastructure domains. Innovative new technologies should be employed to allow consistent, high-quality surgical care to continue even in times of crisis.

Conclusions

If robust progress towards global surgery goals for 2030 is to continue, the stress points identified should be reinforced. An ongoing process of reappraisal and fortification will keep surgical systems in low- and middle-income countries responsive to “old threats and new challenges”. Multiple opportunities exist to help realise the dream of surgical systems resilient to external shocks.

Martinez-Alvarez M, Jarde A, Usuf E et al (2020) COVID-19 pandemic in west Africa. Lancet Glob Health. https://doi.org/10.1016/S2214-109X(20)30123-6 CrossRefPubMedPubMedCentral

WHO Director-General’s opening remarks at the media briefing on COVID-19–11 Mar 2020. https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19—11-march-2020. Accessed 9 Apr 2020

Gates B (2020) Responding to Covid-19—a once-in-a-century pandemic? N Engl J Med 382:1677–1679. https://doi.org/10.1056/NEJMp2003762 CrossRefPubMed

Tanne JH (2020) Americans are told to wear cloth masks. BMJ. https://doi.org/10.1136/bmj.m1411 CrossRefPubMed

Shrime MG, Bickler SW, Alkire BC, Mock C (2015) Global burden of surgical disease: an estimation from the provider perspective. Lancet Glob Health 3:S8–S9. https://doi.org/10.1016/S2214-109X(14)70384-5 CrossRefPubMed

Meara JG, Leather AJM, Hagander L et al (2015) Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet 386:569–624. https://doi.org/10.1016/S0140-6736(15)60160-X CrossRefPubMed

Alkire BC, Shrime MG, Dare AJ et al (2015) Global economic consequences of selected surgical diseases: a modelling study. Lancet Glob Health 3:S21–S27. https://doi.org/10.1016/S2214-109X(15)70088-4 CrossRefPubMedPubMedCentral

Ademuyiwa A, Bekele A, Berhea A et al (2020) COVID-19 preparedness within the surgical, obstetric and anesthetic ecosystem in Sub Saharan Africa. Ann Surg. https://doi.org/10.1097/SLA.0000000000003964 CrossRefPubMedPubMedCentral

Kruk ME, Myers M, Varpilah ST, Dahn BT (2015) What is a resilient health system? Lessons from Ebola. Lancet 385:1910–1912. https://doi.org/10.1016/S0140-6736(15)60755-3 CrossRefPubMed

10.

World Health Organisation (2020) Maintaining a safe and adequate blood supply during the pandemic outbreak of coronavirus disease (COVID-19). World Health Organisation, Geneva

11.

Franchini M, Farrugia A, Velati C et al (2020) The impact of the SARS-CoV-2 outbreak on the safety and availability of blood transfusions in Italy. Vox Sang. https://doi.org/10.1111/vox.12928 CrossRefPubMedPubMedCentral

12.

Elston JWT, Cartwright C, Ndumbi P, Wright J (2017) The health impact of the 2014–15 Ebola outbreak. Public Health 143:60–70. https://doi.org/10.1016/j.puhe.2016.10.020 CrossRefPubMed

13.

Newman M (2020) Covid-19: doctors’ leaders warn that staff could quit and may die over lack of protective equipment. BMJ. https://doi.org/10.1136/bmj.m1257 CrossRefPubMed

14.

Sm H, Rs K-L, Cw M, Js W (2005) Fear of severe acute respiratory syndrome (SARS) among health care workers. J Consult Clin Psychol 73:344–349. https://doi.org/10.1037/0022-006x.73.2.344 CrossRef

15.

Abolfotouh MA, AlQarni AA, Al-Ghamdi SM et al (2017) An assessment of the level of concern among hospital-based health-care workers regarding MERS outbreaks in Saudi Arabia. BMC Infect Dis 17:4. https://doi.org/10.1186/s12879-016-2096-8 CrossRefPubMedPubMedCentral

16.

Malawi health workers protest against lack of protective gear. https://www.aljazeera.com/news/2020/04/malawi-health-workers-protest-lack-protective-gear-200414165616071.html. Accessed 5 May 2020

17.

Chingono N (2020) Doctors sue Zimbabwe government over lack of Covid-19 protective equipment. Guardian. https://www.theguardian.com/global-development/2020/apr/09/doctors-sue-zimbabwe-government-over-lack-of-covid-19-protective-equipment. Accessed 5 May 2020

18.

(2020) COVID-19: Nigeria Medical Association asks doctors on strike to resume duty. In: CNBC Afr. https://www.cnbcafrica.com/west-africa/2020/03/24/covid-19-nigeria-medical-association-asks-doctors-on-strike-to-resume-duty/. Accessed 5 May 2020

19.

Hagopian A, Zuyderduin A, Kyobutungi N, Yumkella F (2009) Job satisfaction and morale in the ugandan health workforce. Health Aff (Millwood) 28:w863–w875. https://doi.org/10.1377/hlthaff.28.5.w863 CrossRef

20.

Bundu I, Patel A, Mansaray A et al (2016) Surgery in the time of Ebola: how events impacted on a single surgical institution in Sierra Leone. BMJ Mil Health 162:212–216. https://doi.org/10.1136/jramc-2015-000582 CrossRef

21.

Daniels KM, Riesel JN, Verguet S et al (2020) The scale-up of the global surgical workforce: can estimates be achieved by 2030? World J Surg 44:1053–1061. https://doi.org/10.1007/s00268-019-05329-9 CrossRefPubMed

22.

Valdez CD, Nichols TW (2013) Motivating healthcare workers to work during a crisis: a literature review. J Manag Pol Pract 14:43–51

23.

Campbell J, Dussault G, Buchan J et al (2013) A universal truth: no health without a workforce. Global Health Workforce Alliance and World Health Organization, Geneva

24.

Bolkan HA, Bash-Taqi DA, Samai M et al (2014) Ebola and indirect effects on health service function in Sierra Leone. PLOS Curr Outbreaks. https://doi.org/10.1371/currents.outbreaks.0307d588df619f9c9447f8ead5b72b2d CrossRef

25.

Wren SM, Kushner AL (2018) Where is the official guidance on Ebola and surgery? Lancet 391:2321–2322. https://doi.org/10.1016/S0140-6736(18)31225-X CrossRefPubMed

26.

Schull MJ, Stukel TA, Vermeulen MJ et al (2007) Effect of widespread restrictions on the use of hospital services during an outbreak of severe acute respiratory syndrome. CMAJ 176:1827–1832. https://doi.org/10.1503/cmaj.061174 CrossRefPubMedPubMedCentral

27.

Gona CV (2020) Letter to the editor: Cancellation of elective surgery during the COVID-19 pandemic. East Cent Afr J Surg 25:18

28.

Tsao H-M, Sun Y-C, Liou D-M (2015) A rational approach to estimating the surgical demand elasticity needed to guide manpower reallocation during contagious outbreaks. PLoS ONE 10:e0122625. https://doi.org/10.1371/journal.pone.0122625 CrossRefPubMedPubMedCentral

29.

COVIDSurg Collaborative (2020) Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans. BJS 10:10. https://doi.org/10.1002/bjs.11746 CrossRef

30.

COVIDSurg Collaborative (2020) Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study. Lancet, 3–5

31.

Lei S et al (2020) Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection. EClinicalMedicine. https://doi.org/10.1016/j.eclinm.2020.100331 CrossRefPubMedPubMedCentral

32.

Hakim AA, Kellish AS, Atabek U et al (2020) Implications for the use of telehealth in surgical patients during the COVID-19 pandemic. Am J Surg. https://doi.org/10.1016/j.amjsurg.2020.04.026 CrossRefPubMedPubMedCentral

33.

Changoiwala P (2020) The doctors navigating covid-19 with no internet. BMJ. https://doi.org/10.1136/bmj.m1417 CrossRefPubMed

34.

Navarro S, Mazingi D, Keil E et al (2020) Identifying new frontiers for social media engagement in global surgery: an observational study. World J Surg. https://doi.org/10.1007/s00268-020-05553-8 CrossRefPubMedPubMedCentral

35.

Nakibuuka J, Semwanga A, Were M (2019) Implementation of USSD technology to improve quality of routinely reported health data in a resource-limited setting. Atudies Health Technol Inf 262:162–165. https://doi.org/10.3233/SHTI190042 CrossRef

36.

Pittalis C, Brugha R, Crispino G et al (2019) Evaluation of a surgical supervision model in three African countries—protocol for a prospective mixed-methods controlled pilot trial. Pilot Feasibility Stud 5:25. https://doi.org/10.1186/s40814-019-0409-6 CrossRefPubMedPubMedCentral

37.

Verguet S, Alkire BC, Bickler SW et al (2015) Timing and cost of scaling up surgical services in low-income and middle-income countries from 2012 to 2030: a modelling study. Lancet Glob Health 3:S28–S37. https://doi.org/10.1016/S2214-109X(15)70086-0 CrossRefPubMed

38.

Bolkan HA, Schreeb JV, Samai MM et al (2015) Met and unmet needs for surgery in Sierra Leone: a comprehensive, retrospective, countrywide survey from all health care facilities performing operations in 2012. Surgery 157:992–1001. https://doi.org/10.1016/j.surg.2014.12.028 CrossRefPubMed

39.

Gutnik LA, Yamey G, Dare AJ et al (2015) Financial contribution to global surgery: an analysis of 160 international charitable organisations. Lancet 385:S52. https://doi.org/10.1016/S0140-6736(15)60847-9 CrossRefPubMed

40.

Gutnik L, Dieleman J, Dare AJ et al (2015) Funding allocation to surgery in low and middle-income countries: a retrospective analysis of contributions from the USA. BMJ Open 5:e008780. https://doi.org/10.1136/bmjopen-2015-008780 CrossRefPubMedPubMedCentral

41.

Kiaga AK, Lapeyre F, Marcadent P (2020) The impact of COVID-19 on the informal economy in Africa and the related policy responses. International Labour Organisation, Geneva

42.

Navarro S, Sibiya A, Nourian M et al (2020) Addressing supply chain management issues in cost-effective maternal and pediatric global surgery: a call to action. Int J MCH AIDS 9:77–80. https://doi.org/10.21106/ijma.295 CrossRefPubMed

43.

Global Health Supply Chain Technical Assistance—South Africa (2019) USAID USAID global health supply chain program

44.

Feinmann J (2020) PPE: what now for the global supply chain? BMJ. https://doi.org/10.1136/bmj.m1910 CrossRefPubMed

45.

Shokrani A, Loukaides EG, Elias E, Lunt AJG (2020) Exploration of alternative supply chains and distributed manufacturing in response to COVID-19; a case study of medical face shields. Mater Des 192:108749. https://doi.org/10.1016/j.matdes.2020.108749 CrossRefPubMedCentral

46.

Truché P, Shoman H, Reddy CL et al (2020) Globalization of national surgical, obstetric and anesthesia plans: the critical link between health policy and action in global surgery. Glob Health 16:1. https://doi.org/10.1186/s12992-019-0531-5 CrossRef

47.

The Global Surgery Foundation (2020) Postponed: high-level workshop on national surgical obstetrical and anaesthesia planning in Nepal

48.

USAID Global Health Supply Chain Program (2019) Best practices in supply chain preparedness for public health emergencies. USAID, Washington

Title: Exploring the Impact of COVID-19 on Progress Towards Achieving Global Surgery Goals
Authors: Dennis Mazingi
Sergio Navarro
Matthew C. Bobel
Andile Dube
Chenesa Mbanje
Chris Lavy
Publication date: 01-08-2020
Publisher: Springer International Publishing
Keywords: COVID-19
Telemedicine
Published in: World Journal of Surgery / Issue 8/2020
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-020-05627-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Exploring the Impact of COVID-19 on Progress Towards Achieving Global Surgery Goals

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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