Two-thirds of the world lacks access to surgery

29 April 2015

Five billion people worldwide do not have access to safe and affordable surgery and anaesthesia when they need it.

As a consequence, millions of people are dying from common, easily treatable conditions like appendicitis, fractures, or obstructed labour. This is according to a major new Commission co-led by experts at King's College London, and published on Tuesday in The Lancet.

Female patient monitored using Lifebox pulse oximeter [essential oxygen monitor] during emergency Caesarean section  

Just under a third of all deaths in 2010 (32·9%, 16·9 million deaths) were from conditions treatable with surgery – well surpassing the number of deaths from HIV / Aids, TB, and malaria combined. 

Surgical access is worst in low-income and lower-middle income countries, where as many as nine out of ten people cannot access basic surgical care.

Despite this enormous burden of death and illness –which is largely borne by the world's poorest people – surgery has, until now, been overlooked as a critical need for the health of the world's population. 

As a result, untreated surgical conditions have exerted substantial but largely unrecognized negative effects on human health, welfare, and economic development.

''In the absence of surgical care, common, easily treatable illnesses become fatal,'' says Andy Leather, director of the King's Centre for Global Health, and one of the Commission's lead authors.  ''The global community cannot continue to ignore this problem – millions of people are already dying unnecessarily, and the need for equitable and affordable access to surgical services is projected to increase in the coming decades, as many of the worst affected countries face rising rates of cancer, cardiovascular disease, and road accidents.''*

Of the 313 million operations done worldwide each year, just one in 20 occur in the poorest countries, where over a third of the world's population lives.  New estimates produced for the Commission find that there is a global shortfall of at least 143 million surgical procedures every year, with some regions needing nearly twice as many additional operations as others.  

The commission estimates that with an investment of $420 billion, a cost far outweighed by the devastating economic costs incurred by the current global shortfall in access to surgery, the countries where access is weakest could be scaled up to acceptable, and achievable, levels of access to surgery by 2030. 

This highly cost-effective investment in surgery needs to be accompanied by sustainable financing mechanisms across the health care system, say the authors, and a firm commitment to universal health coverage.

The Commission was written by a group of 25 leading experts from across the fields of surgery and anaesthesia, with contributions from more than 110 countries.  It calls for recommendations to improve access to safe and affordable surgery and anaesthesia, and a policy template for national surgical plans.

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