Abstract
Global surgery is a slowly emerging field in global health. In 2006, the World Bank published a chapter on Surgery in the second edition of Disease Control Priorities for Developing Countries (DCP2)1 which used a survey of 18 surgeons to estimate the disability-adjusted life years (DALYs) attributable to surgically treatable conditions. The rudimentary methodology used in this study attracted widespread attention. Since then, efforts have been made to better quantify the burden of surgical disease that is currently untreated, and to gain political traction and raise the profile of surgery within global health. The publication of the Lancet Commission on Global Surgery2 (LCoGS) and the Essential Surgery volume of the third edition of Disease Control Priorities for Developing Countries (DCP3)3, together with the passing of the World Health Assembly Resolution on Essential and Emergency Surgical Care4 led to 2015 being described as a ‘banner year’ for global surgery5. Further progress was achieved in 2016 with the incorporation of the first of the LCoGS indicators into the World Bank Development Indicators6, and then, this year, with Zambia producing the first national surgical plan, with other countries like Ethiopia creating strong national programs to improve the quantity and quality of surgical care.The optimism within the global surgery community has not yet translated into any health gains for the poor and marginalised in LMIC settings, partly because only a few countries have begun to develop policies for surgical care, but crucially also because the funding commitments from the international community and national health budgets are not forthcoming. This inertia is unlikely to be overcome without better evidence to inform policy makers and without political prioritization for surgery within the donor community and by Ministers of Finance. At present, the evidence for the enormous burden of death and disability which could be prevented by access to essential surgical care in low and middle income countries (LMICs), is largely based on modelled data, with almost no primary national population level data on surgical conditions. The same applies for the economic data – it is largely based on modelling of the macroeconomic impact of untreated disease7 and modelling of the financial investments required to scale up care8.
The motivation behind these different but related publications was the conviction that in order to realize the vision of universal access to surgical and anaesthesia care globally, there is a need to move from modelled data to primary and country specific data. This thesis brings together five papers all centred around the question: ‘is there any financial incentive for investing in the provision of surgical care in low income countries?’
| Date of Award | 2018 |
|---|---|
| Original language | English |
| Awarding Institution |
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| Supervisor | Andrew Leather (Supervisor) |