The Essential Role of Surgery in Achieving Universal Health Coverage

As featured in the THET February E-Bulletin

“Universal health coverage (UHC) is based upon the conviction that health is a human right, not a privilege. As Director General of the World Health Organization (WHO), I have made UHC my top priority, because I believe it is the best overall investment in health. WHO’s work is about serving people and serving humanity. As part of this mission, access to surgical services and anaesthesia is something to which I am deeply committed.”

So wrote Dr. Tedros, Director General of the WHO, in a message delivered at an official side event during the Universal Health Coverage Forum in Tokyo, Japan on December 12, 2017. This advocacy event, hosted by the WHO, and the governments of Zambia and Zimbabwe, in partnership with the G4 Alliance, the Program in Global Surgery and Social Change at Harvard Medical School, and Johnson & Johnson helped to draw recognition for the essential role of surgery and anaesthesia as part of UHC (Image 1).  World leaders, including Dr. Tedros Adhanom of the WHO, Dr. Jim Yong Kim, President of the World Bank, and Dr. Sania Nishtar, Co-Chair of the High-Level Commission on NCDs, shared strong support for the essential role of surgical and anaesthesia care (Image 2).

Around the world, 5 billion people lack access to safe, affordable surgical and anaesthesia care. This issue cuts across nearly all aspects of health including conditions such as obstructed labor, maternal hemorrhage, congenital birth defects such as clubfoot and cleft lip, traumatic injuries and accidents, soft tissue infections, as well as non-communicable conditions such as cancer and heart disease. Neglected surgical conditions, which comprise one-third of the global burden of disease, could be treated simply and cost-effectively through increased access to essential surgical and anaesthesia care. Access to essential surgical care could save the lives of nearly 17 million people each year, with millions more living free from disability and chronic disease.

The economic impact of surgical inequity also makes surgery essential in achieving UHC, which prioritizes affordability of health services for individuals and the role of health in the economic development of nations. Every year, 81 million people face catastrophic financial expenditure while seeking access to surgery. People are forced to choose between their health and their financial security, and many forgo treatment rather than face financial ruin. Nations that do not invest in surgical care, however, face a steep cost; low and lower-middle income countries stand to lose $12.3 trillion in potential GDP by the year 2030 if they do not make critical investments in surgical care. Achieving the financial imperative of UHC and working towards zero poverty as outlined by the Sustainable Development Goals will require strong health systems and the integration of surgical care as part of primary health coverage.

The barriers to care are numerous: workforce capacity, lack of infrastructure, lack of financing mechanisms, supply chain issues, and a long legacy of under-prioritization at every level of society. To holistically address each of these complex barriers, a coordinated global response was vital. In 2014, the G4 Alliance, a coalition of more than 85 of the world’s leading surgical, obstetric, trauma and anaesthesia care organizations, was formed to advocate for neglected surgical patients around the world. Through this coalition, we are working to develop a shared global advocacy and policy framework for surgical, obstetric, trauma, and anaesthesia care.

While the essential role of surgery as part of UHC has been recognized through political declarations and statements by high level officials, there is still much work to be done. The global surgical community must continue working with the WHO, Member States, and civil society to support integration of surgical care as part of national health plans, and to call for standardized monitoring and reporting of progress worldwide, as organizations like THET are already doing. You can help us take action to call upon world leaders to take the next step in prioritizing collection of surgical and anaesthesia indicators to help track national and global progress. Join us in this advocacy opportunity by February 4th, 2018, and join us throughout the year for additional opportunities to become an advocate for global surgery and health for all!