The Missing Piece in the Struggle for Universal Health Coverage
Too many are dying without access to surgery.
By Rolvix Patterson, B.A. and John Meara, M.D., D.M.D., M.B.A., Harvard Medical School's Program in Global Surgery and Social Change
As darkness fell over Haiti, 7-year-old Taina was fast asleep in her bed beneath the window. Her parents eventually decided to turn in for the night and went to turn off the kerosene lamp. Moments later, oil spilled across Taina’s chest and ignited.
Taina’s parents rushed to tamp down the flame, calling for help, but she had already suffered burns of over 30% of her body. In a region without a comprehensive surgical system, they searched for over a month to find a facility that could care for her massive burns.
Eventually they found a hospital that had a general surgeon, an operating room, and the capability to do skin grafts. Over the next two months, Taina underwent repeated operations, slowly healing and regaining use of her burned arms.
She later returned home to finish healing with a plan for follow-up care. If she hadn’t been lucky enough to find this hospital, she would have suffered lifelong disfigurement and possibly even death from infection.
Stories like this are far too common, and they don’t always end happily.
Too Many Die WIthout Surgery
Five billion people lack access to safe, timely, and affordable surgical, anesthesia, and obstetric care. Over 17 million people die every year as a result.
We know that the situation is worst in low- and middle-income countries where nine out of ten people are disconnected from surgical care.
In the #African continent—with a population of 1.2 billion people—it is estimated that approximately 95% do not have access to safe and affordable surgery: https://t.co/JyDcXyeBbspic.twitter.com/aXNeTRtt84— World Bank (@WorldBank) August 24, 2018
That means that mothers are dying in childbirth when they need a Cesarean section, children have disabilities because they can’t get care for broken bones, and working people can’t support their families due to untreated hernias.
These conditions have a monumental impact on quality and length of life, but many of these are easily treatable. To do that, there needs to be a surgical system and functioning hospitals in place.
Universal Health Coverage Includes Surgery
The United Nations passed a resolution in 2012 declaring the need for Universal Health Coverage (UHC), saying “universal health coverage implies that all people have access to ... promotive, preventive, curative and rehabilitative basic health services needed.”
This vision of creating health systems across the world is based in the understanding that everyone has a right to health care.
We believe that access to surgery is a critical component of UHC and the right to health. As such, it should be included in the development of health systems.
Whether you can access #safesurgery shouldn’t depend on where you live, what job you have or who you’re related to. Surgery is an essential part of #UHC that everyone should have access to .@safesurgery2020#UHC2030#SDG3#GlobalGoalspic.twitter.com/bQ0ad6iiSI— Dalberg (@DalbergTweet) September 25, 2018
In 2015, World Health Assembly resolution 68.15 affirmed this, declaring that essential surgical care and anesthesia is a component of universal health coverage. Three years later, millions of people continue to die because they can’t access basic surgical services.
However, this cause has gained support and progress is being made. In fact, last week at the United Nations General Assembly, access to surgery was promoted by Dr. Sania Nishtar, co-chair of the WHO High-Level Independent Commission on Non-Communicable Diseases, as a key part of an event-wide push to address noncommunicable disease.
The WHA resolution 68.15 passed unanimously in 2015 calls for "strengthening of emergency and essential surgical care and anesthesia as a component of UHC"… It is time we took it seriously in the context of NCDs and UHC #HLM3#NCDs#BeatNCDs#Heartfile@keepark@g4alliance— Sania Nishtar (@SaniaNishtar) September 3, 2018
Breaking Silos by Creating Surgical Systems
Historically, global health has prioritized vertical programs that focus on discrete, measurable tasks like providing immunizations or preventing malaria. However, this siloed approach is not conducive to addressing surgical disease.
Surgery requires an entire functioning hospital, from a working blood bank to a robust supply chain. This means that building surgical systems inherently builds capacity throughout a health system, promoting the goal of achieving UHC.
AR:1/5 billion globally without access to surgery. UHC, access to treatment for NCDs & surgery are intertwined. Integrated solutions needed for problems we try addressing in silos https://t.co/kYLrHH1wA4#GlobalSurgery#HLM3#NCDs#BeatNCDs#Heartfile@keepark@theG4Alliance— Sania Nishtar (@SaniaNishtar) September 3, 2018
Rolvix Patterson, BA is a Research Associate at Harvard’s Program in Global Surgery and Social Change and a medical and public health student at Tufts University School of Medicine. Follow him on twitter @RolvixPatterson.
John Meara, MD, DMD, MBA is the Kletjian Professor of Global Surgery at Harvard Medical School, director of Harvard’s Program in Global Surgery and Social Change, and chief of the Department of Plastic and Oral Surgery at Boston Children's Hospital. Follow him on twitter @JohnMeara.