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Prioritizing essential surgery | Surgery | Volume 155, Issue 3, pp. 365-373 This article is behind a paywall.

“With noncommunicable diseases surpassing infectious diseases as the leading contributors to death and disability worldwide, surgical diseases such as cancer, trauma, and obstetric complications will constitute an increasingly large role of the global burden of disease.”


Background: Surgery has been neglected in low- and middle-income countries for decades. It is vital that the Post-2015 Development Agenda reflect that surgery is an important part of a comprehensive global health care delivery model. We compare the operative capacities of multiple low- and middle-income countries and identify critical gaps in surgical infrastructure.

Methods: The Harvard Humanitarian Initiative survey tool was used to assess the operative capacities of 78 government district hospitals in Bangladesh (7), Bolivia (11), Ethiopia (6), Liberia (11), Nicaragua (10), Rwanda (21), and Uganda (12) from 2011 to 2012. Key outcome measures included infrastructure, equipment availability, physician and nonphysician surgical providers, operative volume, and pharmaceutical capacity.

Results: Seventy of 78 district hospitals assessed performed operations. There was fewer than one surgeon or anesthesiologist per 100,000 catchment population in all countries except Bolivia. There were no physician anesthesiologists in any surveyed hospitals in Rwanda, Liberia, Uganda, or in the majority of hospitals in Ethiopia. Mean annual operations per hospital ranged from 374 in Nicaragua to 3,215 in Bangladesh. Emergency operations and obstetric operations constituted 57.5% and 40% of all operations performed, respectively. Availability of pulse oximetry, essential medicines, and key infrastructure (water, electricity, oxygen) varied widely between and within countries.

Conclusion: The need for operative procedures is not being met by the limited operative capacity in numerous low- and middle-income countries. It is of paramount importance that this gap be addressed by prioritizing essential surgery and safe anesthesia in the Post-2015 Development Agenda. […] Many of the contributors to global morbidity and mortality—trauma, cancer, obstetric complications, cataracts and glaucoma, congenital anomalies, acute abdominal conditions, and perinatal conditions—are potentially amenable to operative intervention. Estimates suggest that these and other surgically treatable diseases constitute approximately 11−25% of the global burden of disease. Moreover, recent household surveys in Rwanda and Sierra Leone have shown that greater than 30% of deaths were associated with surgical conditions.