Surgical leadership in Africa - challenges and opportunities.

Kwabena Frimpong-Boateng,Frank Edwin

doi:10.1515/iss-2018-0036

Abstract

Surgical care has been described as one of the Cinderellas in the global health development agenda, taking a backseat to public health, child health, and infectious diseases. In the midst of such competing health-care needs, surgical care, often viewed by policy makers as luxurious and the preserve of the rich, gets relegated to the bottom of priority lists. In the meantime, infectious disease, malnutrition, and other ailments, viewed as largely affecting the poor and disadvantaged in society, get embedded in national health plans, receiving substantial funding and public health program development. It is often stated that the main reason for this sad state of affairs in surgical care is the lack of political will to improve matters in the health sector. Indeed, in 2001, the Commission on Macroeconomics and Health concluded that the lack of political will to sufficiently increase spending on health at the sub-national, national, and international levels was perhaps the most critical barrier to improving health in low-income countries. However, at the root of this lack of political will is a lack of political priority for surgical care.

Highlights

Surgical care has been described as one of the Cinderellas in the global health development agenda, taking a backseat to public health, child health, and infectious diseases
low-middle income countries (LMICs), the need for surgical services in these regions will continue to rise substantially until 2030 [6]. This forecast is most relevant in sub-Saharan Africa, whose countries are largely of the LMIC extraction
In the case of sub-Saharan Africa and many other LMICs, the Lancet Commission on Global Surgery (LCGS) pointed out that deficits in the surgical workforce are often representative of broad challenges in the public sector, and the lack of national policies and strong coordination led by the central government undermines service delivery

Summary

60 Frimpong-Boateng and Edwin

LMICs, the need for surgical services in these regions will continue to rise substantially until 2030 [6]. Shiffman and Smith’s framework suggests that political priority for surgical care in Africa is low because the proponents of the issue have not communicated a clear policy need using powerful ideas that take advantage of the political contexts of the times. Shiffman and Smith’s seminal paper in 2007 [11] posed the question, “Why do some global health initiatives receive priority from international and national political leaders whereas others receive little attention?” The authors were attempting to explain why after two decades, a global initiative to reduce maternal mortality launched in 1987 appeared stuck in an early phase of development, hampered by several difficulties In their analysis, the authors proposed and applied a framework consisting of four categories: the strength of the actors involved in the initiative, the power of the ideas they use to portray the issue, the nature of the political contexts in which they operate, and the characteristics of the issue itself.

Conclusion

Findings

Frimpong-Boateng and Edwin