The Post‐2015 Development Agenda: The Role of Surgical Care in Improving Health

Abstract

During the past decade and a half, the global health landscape has been characterised by efforts to achieve the millennium development goals (MDGs). These eight health-related objectives agreed upon by the international health community were established in the millennium declaration. The formalisation of these goals and the predefined essential services needed to achieve them has garnered political priority and has been promoted through multiple institutions and organizations [1]. However, as the year 2015 approaches, and with it the target date to achieve the MDGs, attention is increasingly been drawn to the health architecture of the post-MDG era and the health priorities for this next chapter of international health promotion [2]. Key considerations include how to best place health in the post-2015 agenda. With a sizeable proportion of disease burden reducible by surgical intervention [3] coupled with the current inequitable distribution of surgical services globally [4], it is clear that surgical care should play an important role in improving health in the post-2015 era. The challenge of improving access to surgical care in many lowand middle-income countries (LMICs) is well documented in the literature [3]; barriers to care include insufficient accessibility, affordability, availability, and acceptability of care, compounded by a lack of an adequate surgical workforce [5]. Despite these challenges, improving access to surgical care has been shown to be a cost-effective and sustainable intervention that can have simultaneous and reciprocal benefits within a health system [3], and for society as a whole by promoting development through the enhancement of equity, improving economic status by limiting time spent out of work due to disability, and strengthening health systems. Achieving universal health coverage alone, in the 15 years following 2015, will not be enough to ensure that populations currently burdened with disease begin to experience improvements in health. Prevention programmes (for example to reduce road traffic accidents) and continued public health promotion and education accompanied by timely access to healthcare must be imperative to discussion on the post-2015 development agenda. To adequately comprehend the burden of surgical disease in LMICs and evaluate progress towards tackling it, there is a need to establish appropriate metrics to quantify the burden. The utility of relevant metrics will be evident in their ability to aid identification of areas for improvement in terms of operative and postoperative care, infrastructure, human resources, availability of surgical procedures, and essential surgical equipment. Such metrics can also aid in informing global health discourse on surgical care priority setting and advocacy to achieve sustained global awareness in the role of surgery as a post-MDG global health priority. In the year 2000, 189 countries adopted the millennium declaration and set international objectives, which have resulted in tangible gains in global health. In the year 2030, will we acknowledge that our post-MDG era achieved comparable improvements in global health, or will we lament a missed opportunity?