Essential surgery: key messages from Disease Control Priorities, 3rd edition
Charles N Mock, Peter Donkor, Atul Gawande, Dean T Jamison, Margaret E Kruk, Haile T Debas, DCP3 Essential Surgery Author Group, Richard M K Adanu, Sweta Adhikari, Asa Ahimbisibwe, Blake C Alkire, Joseph B Babigumira, Jan J Barendregt, Jessica H Beard, Staffan Bergström, Stephen W Bickler, David Chang, Anthony Charles, Meena Cherian, Thomas Coonan, Dawit Desalegn, Catherine R deVries, Delanyo Dovlo, Richard P Dutton, Mike English, Diana Farmer, Magda Feres, Zipporah Gathuya, Richard A Gosselin, Hideki Higashi, Sue Horton, Renee Hsia, Kjell Arne Johansson, Clark T Johnson, Timothy R B Johnson, Manjul Joshipura, Nicholas J Kassebaum, Ramanan Laxminarayan, Carol Levin, Katrine Lofberg, Svjetlana Lozo, Jackie Mabweijano, Colin McCord, Barbara McPake, Kelly McQueen, John G Meara, Nyengo Mkandawire, Mark A Morgan, Mulu Muleta Bedane, Arindam Nandi, Richard Niederman, Emilia Noormahomed, Florian R Nuevo, Eyitope Ogunbodede, Michael Ohene-Yeboah, Zachary Olson, Andrew Ottaway, Doruk Ozgediz, Caetano Pereira, Mary Lake Polan, N Venkatesh Prajna, Raymond R Price, Shankar Prinja, Thulasiraj D Ravilla, Eduardo Romero Hicks, Sarah Russell, William P Schecter, Nicole Sitkin, Ambereen Sleemi, David Spiegel, Mark G Shrime, Sathish Srinivasan, Andy Stergachis, Amardeep Thind, Stéphane Verguet, Jeffrey R Vincent, Micahel Vlassoff, Johan von Schreeb, Theo Vos, Thomas G Weiser, Iain H Wilson, Ahmed Zakariah, Charles N Mock, Peter Donkor, Atul Gawande, Dean T Jamison, Margaret E Kruk, Haile T Debas, DCP3 Essential Surgery Author Group, Richard M K Adanu, Sweta Adhikari, Asa Ahimbisibwe, Blake C Alkire, Joseph B Babigumira, Jan J Barendregt, Jessica H Beard, Staffan Bergström, Stephen W Bickler, David Chang, Anthony Charles, Meena Cherian, Thomas Coonan, Dawit Desalegn, Catherine R deVries, Delanyo Dovlo, Richard P Dutton, Mike English, Diana Farmer, Magda Feres, Zipporah Gathuya, Richard A Gosselin, Hideki Higashi, Sue Horton, Renee Hsia, Kjell Arne Johansson, Clark T Johnson, Timothy R B Johnson, Manjul Joshipura, Nicholas J Kassebaum, Ramanan Laxminarayan, Carol Levin, Katrine Lofberg, Svjetlana Lozo, Jackie Mabweijano, Colin McCord, Barbara McPake, Kelly McQueen, John G Meara, Nyengo Mkandawire, Mark A Morgan, Mulu Muleta Bedane, Arindam Nandi, Richard Niederman, Emilia Noormahomed, Florian R Nuevo, Eyitope Ogunbodede, Michael Ohene-Yeboah, Zachary Olson, Andrew Ottaway, Doruk Ozgediz, Caetano Pereira, Mary Lake Polan, N Venkatesh Prajna, Raymond R Price, Shankar Prinja, Thulasiraj D Ravilla, Eduardo Romero Hicks, Sarah Russell, William P Schecter, Nicole Sitkin, Ambereen Sleemi, David Spiegel, Mark G Shrime, Sathish Srinivasan, Andy Stergachis, Amardeep Thind, Stéphane Verguet, Jeffrey R Vincent, Micahel Vlassoff, Johan von Schreeb, Theo Vos, Thomas G Weiser, Iain H Wilson, Ahmed Zakariah
Abstract
The World Bank will publish the nine volumes of Disease Control Priorities, 3rd edition, in 2015-16. Volume 1--Essential Surgery--identifies 44 surgical procedures as essential on the basis that they address substantial needs, are cost effective, and are feasible to implement. This report summarises and critically assesses the volume's five key findings. First, provision of essential surgical procedures would avert about 1·5 million deaths a year, or 6-7% of all avertable deaths in low-income and middle-income countries. Second, essential surgical procedures rank among the most cost effective of all health interventions. The surgical platform of the first-level hospital delivers 28 of the 44 essential procedures, making investment in this platform also highly cost effective. Third, measures to expand access to surgery, such as task sharing, have been shown to be safe and effective while countries make long-term investments in building surgical and anaesthesia workforces. Because emergency procedures constitute 23 of the 28 procedures provided at first-level hospitals, expansion of access requires that such facilities be widely geographically diffused. Fourth, substantial disparities remain in the safety of surgical care, driven by high perioperative mortality rates including anaesthesia-related deaths in low-income and middle-income countries. Feasible measures, such as WHO's Surgical Safety Checklist, have led to improvements in safety and quality. Fifth, the large burden of surgical disorders, cost-effectiveness of essential surgery, and strong public demand for surgical services suggest that universal coverage of essential surgery should be financed early on the path to universal health coverage. We point to estimates that full coverage of the component of universal coverage of essential surgery applicable to first-level hospitals would require just over US$3 billion annually of additional spending and yield a benefit-cost ratio of more than 10:1. It would efficiently and equitably provide health benefits, financial protection, and contributions to stronger health systems.
Conflict of interest statement
Declaration of interests
DTJ reports grants from the Bill & Melinda Gates Foundation during conduct of the study. AG reports receiving royalties from personal publications on health-care improvement, including surgery and use of checklists. MEK, HTD, PD, and CNM declare no competing interests.
Copyright © 2015 Elsevier Ltd. All rights reserved.
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Source: PubMed