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Mahesh

15/01/24 12:47 PM IST

Need of Global surgery

In News
  • Global surgery is the neglected stepchild in global health. The neglect is more shocking in South Asia which has the largest population globally lacking access to essential surgery.
Global Surgery
  • Global surgery focuses on equitable access to emergency and essential surgery.
  • While it predominantly focuses on low- and middle-income countries (LMICs), it also prioritises access disparities and under-served populations in high-income countries (HICs).
  • These “surgeries” include essential and emergency surgeries such as surgery, obstetrics, trauma, and anaesthesia (SOTA).
  • Despite small differences, there is largely a consensus across multiple international groups on about thirty or so procedures that fall under the umbrella of emergency and essential surgery.
Problem with surgery
  • The LCoGS noted that five billion people or over 70% of the global population lack timely access to safe and affordable surgical care when needed.
  • Most severely, 99% and 96% of the people in low- and lower-middle-income countries (LLMICs) respectively, face access gaps compared to 24% in high-income countries (HICs), which points to a glaring global disparity.
  • Of the five billion people, over 1.6 billion people lacking access live in South Asia.
  • This translates to over 98% of the South Asian population lacking access to safe and affordable SOTA care.
  • In 2010, around 17 million deaths were attributed to surgically treatable conditions, surpassing the combined mortality burden of HIV/AIDS, tuberculosis, and malaria — emphasising the need for improved access.
  • Work from the Global Surg Collaborative has noted that peri-operative mortality is the third most common cause of death just below ischemic heart disease and stroke. This is partly due to the lack of timely care, unsafe surgeries, and limited capacity of surgical systems.
  • Further, the DCPN comprehensively assessed the disease burden in LMICs that can be averted by scaling up surgical services at district hospitals.
  • It found LMICs to have over 77 million surgically avertable Disability-Adjusted Life-Years (DALY) that formed 3.5% of the total disease burden in these countries. Among regions, South Asia had a higher DALY rate than the LMIC average.
  • South Asia contributed to 50.46%, 32.49%, 26.67%, and 33.35% of the surgically avertable burden of neonatal and maternal diseases, congenital anomalies, digestive conditions, and injuries respectively.
  • Economic loss- The cumulative projected loss to GDP due to the absence of scale-up of surgical care are estimated to be $20.7 trillion (in purchasing power parity terms) across 128 countries by 2030.
  • The annual loss in societal welfare was about $14.5 trillion for 175 countries. South Asia contributes to about 7% of the global lost welfare.
Preventive measures
  • Surgery contributed to <1% of all indicators mentioned in the World Bank, WHO, UNICEF, and other reports.
  • Neglect is also present in national policymaking.
  • An analysis of National Health Strategic Plans from 43 African countries noted that 19% did not mention surgery or surgical conditions at all while 63% mentioned surgery only five times or less.
  • Similarly, an analysis of 70+ years of policymaking in India also noted limited and decreasing attention to surgery.
  • DAH contributions to trauma care are <$1 per DALY compared to $41 per DALY for HIV or $25 for tuberculosis.
  • While U.S. charitable organisations and foundations have spent several million on surgical care in LMICs, these are driven mainly toward specific diseases such as cleft palate, obstetric fistula, and ophthalmic issues, leaving strengthening surgical systems up to individual countries.
  • For example, of the $105 million spent by 470 U.S. foundations from 2003 to 2013, only $7.1 million and $1.7 million went to the training of local surgical providers, and infrastructure respectively.
Way forward
  • In South Asia, Pakistan has formulated a National Surgical Care Vision, Nepal has initiated an NSOAP, and the Pradhan Mantri Jan Arogya Yojana has provided millions of surgeries at zero or negligible cost to the bottom 40% of Indians.
  • Research and innovation, policy focus, and sustained financing are key to solving global surgery challenges.
Source- The Hindu

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