Global Surgery & Anaesthesia Statistics

24 Pages·2017·3.71 MB·English

Global Surgery &
Anaesthesia Statistics
The Importance of Data Collection
Global Surgery & Anaesthesia Statistics
The Importance of Data Collection
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© 2018 German Global Surgery Association / Program in Global Surgery and Social Change at Harvard Medical School / The
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Surgery and Anaesthesia Statistics: The Importance of Data Collection. New York: The G4 Alliance. 2018 License: CC BY-NC-SA
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Cover photo courtesy of ReSurge International, © Josh Estey
Copyright page photo courtesy of Mending Kids
Contents page photo courtesy of the Right to Heal
Photo pages v & vi, 5 & 6, 11 & 12, courtesy of Mending Kids, Mission Haiti 2018
Photo pages Content, ii, iii, 1 & 2, 7 & 8 courtesy of the Right to Heal
Photo pages i, iv, 3 & 4, 9 & 10, 13 & 14 courtesy of Mending Kids
CONTENTS
Abbreviations....................................................................... i
Acknowledgements .............................................................. ii
Executive Summary ..............................................................iv
Signatories...........................................................................v

Introduction........................................................................ 1
Definitions.. ........................................................................ 4
Measurement in Global Surgery ............................................. 5
Current Global Anaesthesia & Surgery Metrics ...........................5
Evaluation of Present Situation & Need for Action ......................6
Data Sources for Surgical Statistics ......................................... 9
The Way Forward ................................................................ 11
ABBREVIATIONS

DCP3 Disease Control Priorities 3
EHR Electronic Health Records
G4 Alliance Global Alliance for Surgical, Obstetric,
Trauma, and Anaesthesia Care
GDP Gross Domestic Product
GIEESC Global Initiative on Emergency and Essential Surgical
Care
GSSA German Global Surgery Association
HIS Health Information Systems
IHS Integrated Household Survey
LCoGS Lancet Commission on Global Surgery
LMIC Low- and Middle-Income Countries
MEASURE DHS Monitoring and Evaluation to Assess and Use Results,
Demographic and Health Surveys
MICS Multiple Indicator Cluster Surveys
MoH Ministry of Health
NGO Non-Governmental Organization
NSO National Statistics Office
PGSSC Program in Global Surgery and Social Change
PHR Personal Health Records
POMR Perioperative Mortality Rate
SARA Service Availability and Readiness Assessment
SDGs Sustainable Development Goals
SPA Service Provision Assessment
UHC Universal Health Coverage
USAID United States Agency for International Development
WDI World Development Indicators
WHA World Health Assembly
WHO World Health Organization
WHO-SAT World Health Organization Situational Analysis Tool
i
ACKNOWLEDGEMENTS
This policy brief was written by the German Global Surgery Association and the Program in
Global Surgery and Social Change at Harvard Medical School. Design and publishing by the
Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care (The G4 Alliance).
We would like to thank the writing team for making this publication possible:
Sabrina Juran (Technical University Munich, Department of Epidemiology), David Ljungman
(Program in Global Surgery and Social Change, Harvard Medical School), Magdalena Gruendl
(German Global Surgery Association, Program in Global Surgery and Social Change, Harvard
Medical School, and Technical University Munich, Department of Epidemiology), Issy Marks
(Academic Foundation Training, Imperial College London, and InciSioN)
We would also like to thank the following contributors for their guidance and input:
John G. Meara (Program in Global Surgery and Social Change, Harvard Medical School), Walter
Johnson (Emergency & Essential Surgical Care Programme, Service Delivery and Safety, Health
Systems and Innovation, World Health Organization), Emmanuel Malabo Mwenda Makasa
(University of Witwatersrand), Fizan Abdullah (Lurie Children’s Hospital, The G4 Alliance), Ruben
Ayala (Operation Smile, The G4 Alliance), Laurie Baumann (Lurie Children’s Hospital), Niclas P.
Broer (German Global Surgery Association and Department for Plastic, Hand and Reconstructive
Surgery, Technical University Munich Teaching Hospital), Justine Davies (Faculty of Life Sciences
and Medicine, King’s College London), Adrian Gelb (Department of Anesthesia & Perioperative
Care, University of California San Francisco), Jose Miguel Guzman (The Demographic Health
Surveillance Program, ICF International), Lars Hagander (Lund University, WHO Collaborating
Centre for Surgery and Public Health), Adil Haider (Center for Surgery and Public Health,
Brigham and Women’s Hospital), Paul I. Heidekrüger (German Global Surgery Association
and Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg),
Hampus Holmer (Lund University, WHO Collaborating Centre on Surgery and Public Health),
Asad Latif (Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University),
Mira Meheš (The G4 Alliance), Bisola Onajin-Obembe (Nigerian Society of Anaesthetists, The G4
Alliance), Gregory Peck (Rutgers Global Surgery), Lubna Samad (Indus Hospital Pakistan), Mark
Shrime (Program in Global Surgery and Social Change, Harvard Medical School and Department
of Otolaryngology, Massachusetts Eye and Ear Infirmary)
Design work by Sarah Hamilton, The G4 Alliance
ii

EXECUTIVE SUMMARY
The Sustainable Development Goals (SDGs) represent When integrated as part of health systems, surgical care
a new global agenda that calls for universal action represents one of the most cost-effective public health
to eradicate poverty, protect the planet and support interventions. Integrating safe, effective and affordable
greater peace and prosperity for all. This inclusive and surgery into existing health systems has been shown to
interconnected agenda provides guidelines and targets contribute to economic gains. For every $1 invested in
for countries and international organizations to track surgical capacity building at the community level, $10
national and global progress, while working collectively is generated through increased health and productivity.
towards sustainable development.
Aligning surgical and anaesthesia care as part of UHC
One of the core tenets of the SDGs is universal health is a powerful strategy for saving lives, and contributes
coverage (UHC), which calls upon world leaders to to the broader sustainable development agenda.
ensure that all people around the world have access However, a robust indicator framework will be essential
to effective, affordable and quality health care when to guide national, regional and global interventions,
needed. The provision of surgical and anaesthesia care and to track progress towards UHC and the sustainable
represents an integral component of UHC and the SDGs. development agenda. The availability of surgical and
anaesthesia data will further provide governments
Recognizing this important linkage, World Health with the information needed to develop, implement
Organization (WHO) Member States unanimously and monitor national policies and allocate resources
approved resolution WHA68.15 during the World effectively.
Health Assembly in May 2015, calling for strengthening
of emergency and essential surgical and anaesthesia This consensus statement focuses on the importance
care as an integral part of UHC. This resolution urges of data collection for surgical and anaesthesia care as
countries to prioritize surgical and anaesthesia care an integral part of the SDG framework. The authors and
as part of national health plans, emphasizing the signatories of this statement call for the establishment
importance of service delivery, quality, training, of an expert working group to analyze and provide
workforce, infrastructure and data collection to recommendations on global surgery and anaesthesia
support monitoring and evaluation. statistics to be presented to the United Nations
Statistical Commission in 2019.
Despite this global momentum, there remains a
paucity of data and information on global surgical and To date, more than 120 global organizations have
anaesthesia care. Experts estimate that nearly 5 billion banded together in support of this consensus
people do not have access to safe, affordable surgical statement. If your organization would like to join this
and anaesthesia care, contributing to as many as 17 global call to action, we invite expressions of interest to
million deaths each year. For those who are able to be sent to the publishers at:

access care, out of pocket costs can be devastating. [email protected].

An estimated 81 million people are impoverished each

year seeking essential surgical services.

iv
SIGNATORIES
This publication has been endorsed by the following global organizations.
Signatories support the recommendations set out in this report.
1. 2nd Chance Association 29. Ethiopian Society of Anesthesiologists
2. African Agency for Integrated Development 30. Fernando Arias
3. Aga Khan Hospital Mombasa 31. FHI 360
4. Alazhari Health Research Center Alzaeim 32. Fistula Foundation
Alazhari University 33. Flowminder Foundation
5. Alliance for Surgery and Anesthesia Presence 34. General Hospital Minna, Nigeria
6. American College of Oral and Maxillofacial 35. German Global Surgery Association
Surgeons 36. Global Paediatric Surgery Network
7. Arbutus Medical 37. Global Pediatric Surgical Technology and
8. Athiriver Shalom Community Hospital Education Project
9. Brain Spine and Rehabilitation Hospital 38. Golden Hour Films
10. Brigham and Women’s Hospital Center for 39. Gradian Health Systems
Surgery and Public Health 40. Harare Central Hospital
11. Canadian Anesthesiologists Society 41. Haukeland University Hospital, Department of
International Education Foundation Anaesthesia and Intensive Care
12. Center for Global Surgery of the McGill 42. HEAL Africa
University Health Center
43. HG Gulf FZ LLC
13. Cents of Relief
44. Hospital Clinica Kennedy, Guayaquil-Ecuador
14. ChildKind International
45. Hospital Español de Veracruz
15. Coast General Hospital
46. ICF International
16. Compassionate Resource Warehouse
47. International Student Surgical Network
17. College of Surgeons of East, Central and
48. International Association of Oral and
Southern Africa
Maxillofacial Surgeons
18. Dalberg Global Development Advisors
49. International Collaboration for Essential
19. Debere Birhan University Surgery
20. Department of Anesthesia, Critical Care and 50. International College of Surgeons
Emergency Medicne at the School of Medicine,
51. International Federation of Nurse Anesthetists
University of Rwanda
52. International Federation of Surgical Colleges
21. Department of Neurosurgery, Inselspital
53. International Society for Burn Injuries
22. Department of Surgery, College of Medicine,
54. International Society of Surgery
University of Lagos
55. Interplast Germany Munich
23. Department of Surgery, Institute of Clinical
56. Jackson Fiah Doe Memorial Regional Referral
Sciences, University of Gothenburg
Hospital
24. Dire Dawa University
57. Jhpiego
25. Discovery Health
58. Johns Hopkins University
26. Dutch Obstetric Anesthesia
59. Jos University Teaching Hospital
27. Edward Francis-Small Teaching Hospital, The
60. Kamenge Military Hosital
Gambia
61. Kamuzu Central Hospital
28. Egerton University Faculty of Health Sciences
62. Karolinska Institutet
v
63. King’s Centre for Global Health & Health 98. Selfless
Partnerships, King’s College London 99. Smile Train
64. King Faisal Hospital, Kigali 100. Society of Obstetric Anaesthetists of Nigeria
65. Korle-Bu Neuroscience Foundation 101. St. Francis Community Mission Hospital
66. Lifebox 102. Stanford Surgery
67. Lodwar County Referral Hospital 103. Sudanese Urological Association
68. Lund University 104. Surgery For the People/Operation Smile
69. Lurie Children's Hospital Nicaragua
70. Makerere University 105. Surgical Section, Vaiola Hospital, Nukualofa,
71. Mazabuka General Hospital Tonga
72. Mending Kids 106. SURG UP
73. Mercy Ships 107. Tamale Teaching Hospital, Tamale-Ghana
74. Ministry of Health, Zambia 108. The Finnish Association of Nurse Anesthetists
75. Moroccan Society of Anesthesia, Analgesia and 109. The G4 Alliance
Intensive Care 110. The Indus Hospital
76. Mulago National Referral Hospital, Burns and 111. Topigs
Plastic Surgery Unit 112. UCSF Center for Global Surgical Studies
77. National Hospital Nigeria, Division of Pediatric 113. Universidade do Estado do Amazonas
Surgery, Department of Surgery 114. University Hospital Carl Gustav Carus
78. Ndajiwo Foundation 115. Dresden
79. NHS 116. University of Adelaide
80. Nigerian Society of Anaesthetists 117. University of Cape Town
81. Northwestern University 118. University of Edinburgh / National Institute
82. Netherlands Society for International Surgery for Health Research Unit on Global Surgery
119. University of Ferrara, Italy
83. Nyamira County Hospital
120. University of Naples Federico II
84. Operation Smile
121. University of Toronto
85. Pan African Academy of Christian Surgeons
122. University of Utah Center for Global Surgery
86. Pacific Islands Surgeons Association
123. Utopian Health Services Ltd
87. Pan Africa Paediatric Surgery Association
124. Vraeyda Media
88. Parirenyatwa Hospital
125. WHO Collaborative Centre for Surgery and
89. Physicians for Peace
Public Health at Lund University
90. Program in Global Surgery and Social Change,
126. World Federation of Associations of Pediatric
Harvard Medical School
Surgery
91. ReSurge International
127. World Federation Of Neurosurgical Societies
92. Rotaplast International Inc.
128. World Federation of Societies of
93. Royal Australasian College of Surgeons
Anaesthesiologists
94. Rutgers University
129. World Health Organization
95. Rwanda Society of Anesthesiology
96. Rwanda Surgical Society
97. Safe Surgery 2020
vi
Global Surgery & Anaesthesia
Introduction Figure 1. The Scale of the Problem
There is increasing acknowledgement of the linkages
among universal access to surgical, obstetric and
anaesthesia care, global health and sustainable
development. Within the context of the 2030 agenda
with its seventeen Sustainable Development Goals
(SDGs), the aspiration for universal health coverage
(UHC) and the 2015 World Health Assembly (WHA)
Resolution 68.15, recognizing the importance of
surgical care and anaesthesia as part of UHC,1 there
has never been a more opportune time for the
international community, members of the research
community, and the medical communities to merge
efforts to support the integration of surgical and
anaesthesia care into the global health agenda.
In the report “Global Surgery 2030: Evidence
and Solutions for Achieving Health, Welfare, and
Economic Development”, the Lancet Commission on
Global Surgery (LCoGS) highlighted that worldwide,
five billion people do not have access to safe,
affordable surgical and anaesthesia care when
needed, and that between 28 percent and 32 percent
of the global burden of disease requires surgical
care, anaesthesia management, or both (Figure 1).2,3 Figure 2. Disparity in
Access is most limited in low- and middle-income Global Distribution of Surgical Procedures
countries (LMICs), where nine out of ten people
cannot access basic surgical care. Untreated, many
surgical conditions are a source of lifetime disability
and can cause premature mortality4 – surgical
conditions claim an estimated 16.9 million lives per
year.5
In 2012, it was estimated that 143 million additional
surgical procedures are needed in LMICs every year
to prevent disability, economic loss, and to save
lives. Of the 313 million procedures undertaken
worldwide each year, only 6 percent occur in the
poorest countries, where over one third of the
world’s population lives (Figure 2).6 Low operative
volumes are associated with higher case-fatality
rates from common, treatable surgical conditions.
The unmet need is greatest in eastern, western, and
central sub-Saharan Africa, and south Asia.
In 2015, the World Bank launched the first volume
of its Disease Control Priorities 3rd edition (DCP3),
dedicated to Essential Surgery, where 44 surgical
procedures were identified as essential for
population health.7 The scope of diseases requiring
1