Campaign Success: Surgical Care included in Global List of 100 Core Health Indicators

Recently, the G4 Alliance launched a campaign in collaboration with the Lancet Commission on Global Surgery.  As part of this campaign, over 120 global surgical, obstetric, trauma, and anaesthesia federations, societies, academic institutions, and non-governmental organizations, endorsed an open letter published in the Lancet calling upon the WHO, the World Bank, and USAID to prioritize surgical care indicators.  We are pleased to announce that as a result of our collective advocacy efforts, surgical care indicators have been included the 2015 WHO Core Reference List of 100 Health Indicators (Update: Surgical Indicators also included in the 2018 Core Indicators reference document which includes health-related indicators relating to the Sustainable Development Goals). 

The following surgical care indicators have been included in the latest version WHO Core Reference List of 100 Health Indicators

1. Quality and Safety of Care in Health Systems

Perioperative Mortality Rate (POMR): All cause death rate prior to discharge among patients having one or more procedures in an operating theatre during the relevant admission.  Data collected by region/health facility and age for emergency and elective surgery. Includes measurement of surgical volume per 100,000 population.

2. Access to Care. 

Health Service Access: Percentage of population living within 5km of a health facility. Access to Emergency Surgery measured. Includes measurement of total number of health facilities per 10, 000 population.

3. Health Workforce: 

Health Worker Density:  Number of health workers per 1,000 population. Includes measurement of core professionals and specialists including surgeons and place of employment (urban/rural) and district. 

Our campaign also included a call for indicators to measure the fraction of households protected against catastrophic expense and impoverishment from out-of-pocket payments for surgical care. This indicator represents a key element of universal health coverage and provides information about payment systems, insurance coverage, and balance of public and private services.  While surgery is not explicitly included in reference to catastrophic expense and impoverishment due to out-of pocket payments, we are encouraged to see that these indicators are included as part of the Core 100 list. 

We thank our collaborators at the Lancet Commission on Global Surgery, as well as the many organizations who extended their enthusiastic support for this important campaign.  As a direct result of your support, surgical metrics have been prioritized as part of the WHO’s reference list of 100 core health indicators, a reference guide that will be used to promote greater transparency and consistency in national and international reporting.  Thank you for raising awareness and giving voice to the neglected surgical patient.