Framework for developing a national surgical, obstetric and anaesthesia plan.

K A Sonderman,R Riviello,W Johnson,I Citron,K Taylor,K R Iverson,M L Steer,A Bekele,S Mukhopadhyay,M Nthele,K Albutt,D Jumbam,S Maongezi,E Rwamasirabo,J G Meara

doi:10.1002/bjs5.50190

Abstract

BackgroundEmergency and essential surgical, obstetric and anaesthesia (SOA) care are now recognized components of universal health coverage, necessary for a functional health system. To improve surgical care at a national level, strategic planning addressing the six domains of a surgical system is needed. This paper details a process for development of a national surgical, obstetric and anaesthesia plan (NSOAP) based on the experiences of frontline providers, Ministry of Health officials, WHO leaders, and consultants.MethodsDevelopment of a NSOAP involves eight key steps: Ministry support and ownership; situation analysis and baseline assessments; stakeholder engagement and priority setting; drafting and validation; monitoring and evaluation; costing; governance; and implementation. Drafting a NSOAP involves defining the current gaps in care, synthesizing and prioritizing solutions, and providing an implementation and monitoring plan with a projected cost for the six domains of a surgical system: infrastructure, service delivery, workforce, information management, finance and governance.ResultsTo date, four countries have completed NSOAPs and 23 more have committed to development. Lessons learned from these previous NSOAP processes are described in detail.ConclusionThere is global movement to address the burden of surgical disease, improving quality and access to SOA care. The development of a strategic plan to address gaps across the SOA system systematically is a critical first step to ensuring countrywide scale‐up of surgical system‐strengthening activities.

Highlights

The United Nations and WHO have made universal health coverage (UHC) a clear priority through the Sustainable Development Goals (SDGs)[1]
UHC is defined as all people and communities having access to the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while ensuring that the user of these services is not exposed to financial hardship[2]
In 2015, the Lancet Commission on Global Surgery[5] defined the landscape of surgical care worldwide and laid out an initial framework for how low- and middle-income countries could address the gaps in care in order to provide safe, affordable and quality surgical care

Summary

Background

Obstetric and anaesthesia (SOA) care are recognized components of universal health coverage, necessary for a functional health system. This paper details a process for development of a national surgical, obstetric and anaesthesia plan (NSOAP) based on the experiences of frontline providers, Ministry of Health officials, WHO leaders, and consultants. Drafting a NSOAP involves defining the current gaps in care, synthesizing and prioritizing solutions, and providing an implementation and monitoring plan with a projected cost for the six domains of a surgical system: infrastructure, service delivery, workforce, information management, finance and governance. Results: To date, four countries have completed NSOAPs and 23 more have committed to development Lessons learned from these previous NSOAP processes are described in detail. The development of a strategic plan to address gaps across the SOA system systematically is a critical first step to ensuring countrywide scale-up of surgical system-strengthening activities

Introduction

Procedures done in an operating

Results chain

Limitations

Conclusion