Way Back in 1980 Dr H. Mahler, the Director General of the WHO in his address to the Biennial World Congress of International College of Surgeons in Mexico has identified surgery as an essential component of the larger global agenda of “Health for All” .The concept of “primary care and health for all” has at that time been freshly ratified in the historical Alma-Ata declaration in 1978 in USSR.And yet today-in 2012 more than 30 years later we are faced with the raw truth that approximately 2 billion people worldwide do not have any access to basic surgical care.
Analyzed on a country level the huge disparities between developed and the developing and underdeveloped nations is shocking. ” 4 billion people undergo 96.5% of all surgical procedures, whereas the poorest 2 billion people undergo only 3.5% of all surgical procedures “(Abdullah F,Troeddson H , Cherian M. The World Health Organization Program for Emergency Surgical, Obstetric, and Anesthetic Care From Mongolia to the Future.SURG. 2011;146(5):620-623)
A large part of this disparity is on account of the fact that most health planes has considered surgery a low priority field. They think that surgery is only a small part of the global burden of disease and that an effective surgical system can be put in place only after a proper health system based on medicine has been worked out. However facts reveal that 11% of the global disease burden need surgical treatment and surgical services and infrastructure can be integrated into existing health systems effectively.(Data from WHO EESC website)
With the agenda of “ Surgery and Health for all” ruling prime a global forum called the WHO Global Initiative for Emergency and Essential Surgical Care(GIESSC) was established by WHO Emergency and Essential Surgical Care program in 2005 after a meeting at the WHO headquarters in Geneva.
This WHO GIEESC brings together professionals from all disciplines, universities and organizations who are interested in addressing issues of universal access to surgical (including anaesthesia, trauma, obstetrics too) care in developing countries. In developing countries particularly in district level health facilities, there are huge gaps to deliver appropriate surgical services in terms of infrastructure, skilled health personnel, equipment, supplies and medications to save lives and prevent disability as a result of road traffic accidents, violence, disaster situation, childbirth complications, congenital anomalies and other surgical conditions.
To address these issues GIESSC key activity besides research is to work towards education and training of health workers and optimisation of available health systems through evidence based cost effective interventions. For the purpose of training and education in the field of surgery it has made available online the free copy of the book The Surgical Care at District Hospital WHO Manual. It is a practical resource for individual practitioners as well as in-service training and continuing medical education programmes. It contains the best practise protocols for common surgical problems which can be easily implemented in any hospital at the district level without any difficulty. In addition it makes available seven training videos on essential surgical techniques like basic wound management, management of tendon and soft tissue injuries, and also head and spinal injuries, fractures of the pelvis, upper and lower limbs .The GIESSC has also collaborated to develop the WHO Integrated Management for Emergency & Essential Surgical Care e-learning toolkit which is available at : at www.who.int/surgery . It aims to guide policy makers, managers researchers, and organizations involved in education and training. Health facilities data can be entered online into the WHO EESC global database by utilizing the WHO situation analysis tool to assess emergency, anaesthesia, obstetrics, trauma and surgical services. The data from countries is analysed for free and the recommendations send back for development of the health facility. Scientific papers can be accessed on the website – publications. It also contains various checklists (like Essential Emergency Equipment Generic List, Needs Assessment for Essential Emergency Room Equipment Monitoring & Evalaution tool etcetera) which can be used for better organisation for surgical health systems.
Dr. Soumyadeep Bhaumik
Resident Editor, Your Health
Member, WHO: The Global Initiative for Emergency and Essential Surgical Care (GIEESC)
Article Originally Published in December 2012 issue of Your Health of Indian Medical Association
Isn’t the healthcare issue much broader than just access to surgery? Surgery is but one indicator of unequal access but this probably applies to all areas of medicine, does it not? Inequality within and among nations is likely the biggest health predictor I think.