Disparities in surgical care access are among the direst forms of health inequity. Over 70% of the world’s population and 90% of people living in low- and middle- income countries (LMICs) lack access to basic lifesaving surgical care[1]. In Sub-Saharan Africa, health policies, which are designed to designed advance surgery care delivery are rare and rudimentary [2]. A systematic review of 47 Sub-Saharan African countries’ national health plans for the 2002-2030 period did not find any policy that mentioned general surgical disease (100%) or surgery (19%), and 33 % of policies had no targets relating to surgical care [2]. Thus surgical conditions are neither planned for nor prioritized because they are not on the agenda. Consequently, this creates and perpetuates surgical care disparities on a massive scale as seen in many developing countries.
A National Surgical Obstetrics and Anesthesia Plan (NSOAP) is a national health plan that is used to achieve desired outcomes pertaining to surgical, obstetric and anesthesia care delivery. NSOAPs provide a platform to co-ordinate, prioritize, and elevate efforts and resources to ensure optimum quality, safety, affordability, and access to surgical and anesthesia care. It is important for decision-making and resource allocation. The process of developing NSOAPs brings together key stakeholders including healthcare providers; implementation specialists, advocacy groups, and policymakers to work on problems affecting the current state of the surgical system and create solutions. It is an iterative process involving: 1) planning, 2) developing a national forum, and 3) implementation [3]. The result is a context-appropriate action plan that is essential to addressing the existing surgical disparities.
Recent events in the global health arena have created a policy window that can be leveraged to place key surgical issues on the global and national health agenda. Historically, governments in LMICs have not prioritized surgical care delivery. This may be partly because surgical conditions did not feature in the Millennium Development Goals (MDGs), which guided the global health agenda in the 1990 – 2015 era. The advent of the United Nations’ Post-2015 Sustainable Development Goals (SDGs), has adjusted the focus towards achieving Universal Health Coverage (UHC). In 2015, the World Health Assembly (WHA) passed a resolution (WHA68:15), which recognized strengthening emergency and essential surgical care and anesthesia an essential component of UHC. In May 2017, the WHA passed resolution WHA70.22 (2017), which requires the WHO Director-General, and WHA member nations, to provide a biennial report the on strengthening of emergency and essential surgical care and anesthesia as a component of universal health coverage as requested in resolution WHA69:11 (2016). These series of global events highlight the importance of the need to place surgery, obstetrics, and anesthesia on the national health agenda as a priority issue.
In line with these events, the quest to develop NSOAPs in LMICs is quickly gaining momentum, with countries like Zambia, India, Tanzania, and Cape Verde currently on the path towards developing NSOAPs[4]. This has been made possible largely through partnerships between countries, academic institutions, advocacy groups and other allied entities that share the same goal.
NSOAP development support has been one of the areas of focus of the G4 Alliance. The G4 Alliance is an organization dedicated towards building political priority for anesthesia and surgical care as part of the global development agenda[5]. The G4 Alliance plays a key role in engaging key stakeholders (e.g. the WHO, Ministries of Health, academic institutions, etc.) and advocating for the neglected surgical patient. Comprising of over 80 organizations in over 160 countries, the G4 Alliance also works to mobilize resources to help provide access to safe surgical care for patients in need. In July 2015, the G4 Alliance and its partners began a global consultative process designed to collect input and build consensus for a Global Action Plan for Surgery, which will guide the G4 Alliance’s advocacy, policy implementation, and resource mobilization strategy in order to improve surgical, obstetric, and anesthesia care worldwide[6]. During the G4 Alliance member meeting at the World Health Assembly this year, the G4 called on its members to support NSOAP development and identified resource mobilization to catalyze funding for NSOAP implementation as an area of advocacy.
The need for NSOAPs in LMICs presents unique opportunities individuals, institutions, and countries to partner in an effort to further prioritize surgical care delivery at a national level. The G4’s call for a Global Action Plan for Surgery leverages member organizations to find a common voice and work collaboratively with others to gather evidence, formulate policies, and implement interventions to advocate for and improve surgical and anesthesia care access worldwide. This painstaking policy work sets the foundation for the future critical steps towards strengthening surgical care for those who need it most.