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In the realm of global health, surgery often takes a backseat to more immediate concerns like infectious diseases and malnutrition. However, the importance of surgical care cannot be overstated. With over 5 billion people lacking access to safe and affordable surgical and anaesthesia care, the global burden of surgical disease is a pressing issue that demands attention.
Synopsis
The Global Burden of Surgical Disease
Surgical diseases account for approximately 30% of the global disease burden. This includes conditions that require surgical intervention, such as trauma, cancer, congenital anomalies, and obstetric complications. Despite this significant impact, surgical care receives only a fraction of global health funding. In 2010 alone, 16.9 million lives were lost due to untreated surgical conditions.
Disparities in Access to Surgical Care
The disparities in access to surgical care are stark. Low- and middle-income countries (LMICs) bear the brunt of this burden. While these countries make up over a third of the world's population, they account for only 6% of all surgeries performed globally. This means that millions of people in these regions suffer or die from conditions that could be treated with timely surgical intervention.
In LMICs, the failure to treat surgical conditions leads to approximately 4.7 million deaths annually, representing 10% of all deaths worldwide. High perioperative mortality rates, with a substantial contribution from anaesthesia-related deaths, remain a significant barrier. The rate of anaesthesia-related death in these countries can be as much as 100 times higher than in high-income countries (HICs).
The Role of Global Surgery
Global surgery is the study and practice of improving access to timely, quality, and affordable surgical care worldwide. It is an essential component of global health, contributing to the achievement of several Sustainable Development Goals (SDGs) by 2030. These goals include reducing maternal mortality, ending preventable deaths of newborns and children under five, and combating non-communicable diseases.
Challenges and Barriers
Several challenges hinder the provision of surgical care in LMICs. These include:
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Infrastructure Deficiencies: Many LMICs lack the necessary infrastructure, including operating rooms, surgical equipment, and sterile supplies.
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Shortage of Trained Providers: There is a significant shortage of trained surgeons, anaesthesiologists, and other healthcare professionals.
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Financial Barriers: The cost of surgical care can be prohibitive for many people in LMICs, leading to catastrophic health expenditures.
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Policy Neglect: Surgical care often receives less attention in national health policies compared to other health interventions.
Indian Insights
India, as the largest lower-middle-income country, faces significant challenges in providing surgical care to its vast population. Over 90% of India's 1.4 billion people lack timely access to safe and affordable surgical care. This is a critical issue, given that India contributes one-fifth of the global population that lacks access to essential and emergency surgery.
Despite these challenges, India has made notable strides in improving surgical care. The Pradhan Mantri Jan Arogya Yojana (PM-JAY) has been a game-changer, providing millions of surgeries at zero or negligible cost to the bottom 40% of Indians. This initiative has significantly reduced the financial burden on families and improved access to surgical care for the most vulnerable populations.
However, there are still significant barriers to overcome. The shortage of trained surgeons, obstetricians, and anaesthetists remains a major issue. Additionally, there is a need for more comprehensive data at the subnational level to develop an evidence-based National Surgical, Obstetric, and Anaesthesia Plan (NSOAP) for India. This plan would help identify contextually relevant priorities and targets, ensuring that surgical care is accessible to all, regardless of geographical location or socioeconomic status.
Success Stories and Initiatives
Despite these challenges, there have been notable successes in improving surgical care in LMICs. For example, India's Pradhan Mantri Jan Arogya Yojana has provided millions of surgeries at zero or negligible cost to the bottom 40% of Indians. Similarly, Pakistan has formulated a National Surgical Care Vision, and Nepal has initiated a National Surgical, Obstetric, and Anaesthesia Plan (NSOAP).
The Way Forward
To bridge the gap in surgical care, several steps need to be taken:
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Investment in Infrastructure: Building and equipping more surgical facilities in LMICs is crucial.
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Training and Retaining Healthcare Professionals: Increasing the number of trained surgeons, anaesthesiologists, and other healthcare workers is essential.
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Financial Protection: Implementing policies that protect individuals from catastrophic health expenditures can improve access to surgical care.
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Policy Advocacy: Advocating for the inclusion of surgical care in national and global health policies can ensure sustained attention and funding.
Conclusion
The global disparities in surgical care are a significant barrier to achieving health equity. By understanding the trends and challenges in global surgery, we can work towards a future where everyone has access to the surgical care they need. Bridging the gap in surgical care requires a concerted effort from governments, international organisations, and the global health community. Together, we can make safe and affordable surgical care a reality for all.
FAQ's
Access to surgical care is crucial because it can prevent deaths and disabilities from treatable conditions. Without timely surgical intervention, millions of people suffer or die from conditions that could be managed effectively.
The rate of anaesthesia-related deaths in LMICs can be as much as 100 times higher than in HICs. This is due to factors such as inadequate training, lack of equipment, and poor infrastructure.
Challenges include infrastructure deficiencies, a shortage of trained providers, financial barriers, and policy neglect. These challenges hinder the provision of safe and effective surgical care.
India has implemented the Pradhan Mantri Jan Arogya Yojana (PM-JAY), which provides millions of surgeries at zero or negligible cost to the bottom 40% of Indians. This initiative has significantly improved access to surgical care for vulnerable populations.
Including surgical care in national health policies ensures sustained attention and funding for surgical services. It helps address the disparities in access to surgical care and improves overall health outcomes.
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