Abstract
More than three years have passed since the publication of the Lancet Commission on Global Surgery and its recommendations on scaling up surgery in sub-Saharan Africa (SSA). An important gap, the voice of the districts as well as lack of contextualized research, has been noted in its support of national surgical plans that run the risk of being at best, aspirational. Moreover, a ‘one-size-fits-all approach’ may not adequately address country-specific challenges on the ground. There is a need to redirect attention, effort, and funding in creating a global mechanism to gather baseline country information documenting every single district level government health facility’s ability and readiness to provide safe surgical, obstetric, trauma, and anesthesia care using the World Health Organization (WHO) Service Availability and Readiness Assessment (SARA) tool to aid in directing country-specific efforts in surgical systems strengthening and ensuring that a basic package of essential surgical and anesthesia services is made available to each citizen with adequate financial protection by 2030. This global mechanism will enable benchmarking, accountability, and streamlining of the work of the global surgical community to achieve true progress in scaling up surgery not only in SSA, but for the rest of the developing world.
Highlights
The accompanying article by Gajewski et al[1] is a critique of the progress made in the three years since the publication of the Lancet Commission on Global Surgery and of efforts in scaling up essential surgical care in sub-Saharan Africa (SSA)
The authors mention the dearth of empirical research on surgical capacity at district-level hospitals (DLHs), which may be accurate considering the fact that the 21 published surgical capacity studies in 17 low- and middle-income countries (LMICs) yielded only seven additional studies with any combination of previous studies with analysis going beyond establishing a baseline.[2]
While increasing attention to assist countries in creating national surgical plans is commendable, several points deserve mention based on lessons learned in past experiences: Expert published recommendations are useful; but needs a targeted advocacy strategy to inform policy-makers who may or may not be cognizant of the academic debates taking place
Summary
The accompanying article by Gajewski et al[1] is a critique of the progress made in the three years since the publication of the Lancet Commission on Global Surgery and of efforts in scaling up essential surgical care in sub-Saharan Africa (SSA).
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