Increasing Access to Surgical Services in Sub-Saharan Africa

A policy paper by an international team of 42 experts lays out four recommendations on how to improve access to surgical services in Sub-Saharan Africa.

The Bellagio Essential Surgery Group (BESG) is a network of surgeons, anesthesiologists, public health professionals, economists, and policy makers committed to raising international awareness and increase access to surgical services in resource constrained settings in sub-Saharan Africa. In their policy paper, BESG make four key recommendations:

1. Strengthen surgical services at district hospitals; the presence of such units would help ensure a functioning blood bank, a clinical laboratory, and the emergency transport and communication systems of a hospital, and thus improve its overall effectiveness.

2. Improve systems for the delivery of trauma care. The components that need to be addressed include improvements in prehospital care, patient management, strengthening of care at clinics and hospitals, streamlining of the referral process, instituting financing mechanisms to remove financial barriers to care, and ensuring adequate data with which to monitor the quality of care provided.

3. Expand the supply and quality of health workers with surgical skills, and establish mechanisms for accreditation and coordination of the training programs within and across countries, and to conduct objective evaluations of their outcomes.

4. Build evidence for creating informed interventions, as there is little evidence to answer even basic questions about the prevalence and incidence of surgical conditions and the provision of surgical interventions in sub-Saharan Africa.

Further plans include collecting additional evidence about the incidence and prevalence of surgical conditions, the gap in service provision, advocacy and dissemination, and establishing demonstration project developments to improve access to surgical services, particularly at the district hospital level in the region. The policy paper was published in the December 2009 issue of PLos Medicine.

"We call on surgeons, public health researchers, health economists, epidemiologists, and social scientists to collaborate to determine research priorities, institute training in appropriate research methods, encourage funders to support surgical research projects and undertake such work together,” exhorted the group of experts. "Lastly, we also call on surgeons, through their regional and national professional associations, to look beyond the walls of their operating theatres to involve themselves in advocacy, training, research, and health service management.”

Sub-Saharan Africa suffers the world's highest burden of conditions and diseases that require surgical treatment. This burden is mainly due to injuries, obstetric complications cancer, neonatal conditions, congenital anomalies, cataracts, and glaucoma. For example, in 2005, over 250,000 women died from complications of childbirth. Most of these deaths could have been avoided by providing women with access to basic obstetric care and obstetric surgical care.

Related Links:
Bellagio Essential Surgery Group