Exploring the Impact of COVID-19 on Progress Towards Achieving Global Surgery Goals

Dennis Mazingi, Sergio Navarro, Matthew C Bobel, Andile Dube, Chenesa Mbanje, Chris Lavy, Dennis Mazingi, Sergio Navarro, Matthew C Bobel, Andile Dube, Chenesa Mbanje, Chris Lavy

Abstract

Introduction: In the 5 months since it began, the COVID-19 pandemic has placed extraordinary demands on health systems around the world including surgery. Competing health objectives and resource redeployment threaten to retard the scale-up of surgical services in low- and middle-income countries where access to safe, affordable and timely care is low. The key aspiration of the Lancet Commission on global surgery was promotion of resilience in surgical systems. The current pandemic provides an opportunity to stress-test those systems and identify fault-lines that may not be easily apparent outside of times of crisis.

Methods: We endeavoured to explore vulnerable points in surgical systems learning from the experience of past outbreaks, using examples from the current pandemic, and make recommendations for future health emergencies. The 6-component framework for surgical systems planning was used to categorise the effects of COVID-19 on surgical systems, with a particular focus on low- and middle-income countries. Key vulnerabilities were identified and recommendations were made for the current pandemic and for the future.

Results: Multiple stress points were identified throughout all of the 6 components of surgical systems. The impact is expected to be highest in the workforce, service delivery and infrastructure domains. Innovative new technologies should be employed to allow consistent, high-quality surgical care to continue even in times of crisis.

Conclusions: If robust progress towards global surgery goals for 2030 is to continue, the stress points identified should be reinforced. An ongoing process of reappraisal and fortification will keep surgical systems in low- and middle-income countries responsive to "old threats and new challenges". Multiple opportunities exist to help realise the dream of surgical systems resilient to external shocks.

Conflict of interest statement

None.

References

    1. Martinez-Alvarez M, Jarde A, Usuf E, et al. COVID-19 pandemic in west Africa. Lancet Glob Health. 2020 doi: 10.1016/S2214-109X(20)30123-6.
    1. WHO Director-General’s opening remarks at the media briefing on COVID-19–11 Mar 2020. . Accessed 9 Apr 2020
    1. Gates B. Responding to Covid-19—a once-in-a-century pandemic? N Engl J Med. 2020;382:1677–1679. doi: 10.1056/NEJMp2003762.
    1. Tanne JH. Americans are told to wear cloth masks. BMJ. 2020 doi: 10.1136/bmj.m1411.
    1. Shrime MG, Bickler SW, Alkire BC, Mock C. Global burden of surgical disease: an estimation from the provider perspective. Lancet Glob Health. 2015;3:S8–S9. doi: 10.1016/S2214-109X(14)70384-5.
    1. Meara JG, Leather AJM, Hagander L, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386:569–624. doi: 10.1016/S0140-6736(15)60160-X.
    1. Alkire BC, Shrime MG, Dare AJ, et al. Global economic consequences of selected surgical diseases: a modelling study. Lancet Glob Health. 2015;3:S21–S27. doi: 10.1016/S2214-109X(15)70088-4.
    1. Ademuyiwa A, Bekele A, Berhea A, et al. COVID-19 preparedness within the surgical, obstetric and anesthetic ecosystem in Sub Saharan Africa. Ann Surg. 2020 doi: 10.1097/SLA.0000000000003964.
    1. Kruk ME, Myers M, Varpilah ST, Dahn BT. What is a resilient health system? Lessons from Ebola. Lancet. 2015;385:1910–1912. doi: 10.1016/S0140-6736(15)60755-3.
    1. World Health Organisation . Maintaining a safe and adequate blood supply during the pandemic outbreak of coronavirus disease (COVID-19) Geneva: World Health Organisation; 2020.
    1. Franchini M, Farrugia A, Velati C, et al. The impact of the SARS-CoV-2 outbreak on the safety and availability of blood transfusions in Italy. Vox Sang. 2020 doi: 10.1111/vox.12928.
    1. Elston JWT, Cartwright C, Ndumbi P, Wright J. The health impact of the 2014–15 Ebola outbreak. Public Health. 2017;143:60–70. doi: 10.1016/j.puhe.2016.10.020.
    1. Newman M. Covid-19: doctors’ leaders warn that staff could quit and may die over lack of protective equipment. BMJ. 2020 doi: 10.1136/bmj.m1257.
    1. Sm H, Rs K-L, Cw M, Js W. Fear of severe acute respiratory syndrome (SARS) among health care workers. J Consult Clin Psychol. 2005;73:344–349. doi: 10.1037/0022-006x.73.2.344.
    1. Abolfotouh MA, AlQarni AA, Al-Ghamdi SM, et al. An assessment of the level of concern among hospital-based health-care workers regarding MERS outbreaks in Saudi Arabia. BMC Infect Dis. 2017;17:4. doi: 10.1186/s12879-016-2096-8.
    1. Malawi health workers protest against lack of protective gear. . Accessed 5 May 2020
    1. Chingono N (2020) Doctors sue Zimbabwe government over lack of Covid-19 protective equipment. Guardian. . Accessed 5 May 2020
    1. (2020) COVID-19: Nigeria Medical Association asks doctors on strike to resume duty. In: CNBC Afr. . Accessed 5 May 2020
    1. Hagopian A, Zuyderduin A, Kyobutungi N, Yumkella F. Job satisfaction and morale in the ugandan health workforce. Health Aff (Millwood) 2009;28:w863–w875. doi: 10.1377/hlthaff.28.5.w863.
    1. Bundu I, Patel A, Mansaray A, et al. Surgery in the time of Ebola: how events impacted on a single surgical institution in Sierra Leone. BMJ Mil Health. 2016;162:212–216. doi: 10.1136/jramc-2015-000582.
    1. Daniels KM, Riesel JN, Verguet S, et al. The scale-up of the global surgical workforce: can estimates be achieved by 2030? World J Surg. 2020;44:1053–1061. doi: 10.1007/s00268-019-05329-9.
    1. Valdez CD, Nichols TW. Motivating healthcare workers to work during a crisis: a literature review. J Manag Pol Pract. 2013;14:43–51.
    1. Campbell J, Dussault G, Buchan J, et al. A universal truth: no health without a workforce. Geneva: Global Health Workforce Alliance and World Health Organization; 2013.
    1. Bolkan HA, Bash-Taqi DA, Samai M, et al. Ebola and indirect effects on health service function in Sierra Leone. PLOS Curr Outbreaks. 2014 doi: 10.1371/currents.outbreaks.0307d588df619f9c9447f8ead5b72b2d.
    1. Wren SM, Kushner AL. Where is the official guidance on Ebola and surgery? Lancet. 2018;391:2321–2322. doi: 10.1016/S0140-6736(18)31225-X.
    1. Schull MJ, Stukel TA, Vermeulen MJ, et al. Effect of widespread restrictions on the use of hospital services during an outbreak of severe acute respiratory syndrome. CMAJ. 2007;176:1827–1832. doi: 10.1503/cmaj.061174.
    1. Gona CV. Letter to the editor: Cancellation of elective surgery during the COVID-19 pandemic. PLoS ONE. 2020;25:18.
    1. Tsao H-M, Sun Y-C, Liou D-M. A rational approach to estimating the surgical demand elasticity needed to guide manpower reallocation during contagious outbreaks. PLoS ONE. 2015;10:e0122625. doi: 10.1371/journal.pone.0122625.
    1. COVIDSurg Collaborative Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans. BJS. 2020;10:10. doi: 10.1002/bjs.11746.
    1. COVIDSurg Collaborative (2020) Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study. Lancet, 3–5
    1. Lei S, et al. Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection. EClinicalMedicine. 2020 doi: 10.1016/j.eclinm.2020.100331.
    1. Hakim AA, Kellish AS, Atabek U, et al. Implications for the use of telehealth in surgical patients during the COVID-19 pandemic. Am J Surg. 2020 doi: 10.1016/j.amjsurg.2020.04.026.
    1. Changoiwala P. The doctors navigating covid-19 with no internet. BMJ. 2020 doi: 10.1136/bmj.m1417.
    1. Navarro S, Mazingi D, Keil E, et al. Identifying new frontiers for social media engagement in global surgery: an observational study. World J Surg. 2020 doi: 10.1007/s00268-020-05553-8.
    1. Nakibuuka J, Semwanga A, Were M. Implementation of USSD technology to improve quality of routinely reported health data in a resource-limited setting. Atudies Health Technol Inf. 2019;262:162–165. doi: 10.3233/SHTI190042.
    1. Pittalis C, Brugha R, Crispino G, et al. Evaluation of a surgical supervision model in three African countries—protocol for a prospective mixed-methods controlled pilot trial. Pilot Feasibility Stud. 2019;5:25. doi: 10.1186/s40814-019-0409-6.
    1. Verguet S, Alkire BC, Bickler SW, et al. Timing and cost of scaling up surgical services in low-income and middle-income countries from 2012 to 2030: a modelling study. Lancet Glob Health. 2015;3:S28–S37. doi: 10.1016/S2214-109X(15)70086-0.
    1. Bolkan HA, Schreeb JV, Samai MM, et al. Met and unmet needs for surgery in Sierra Leone: a comprehensive, retrospective, countrywide survey from all health care facilities performing operations in 2012. Surgery. 2015;157:992–1001. doi: 10.1016/j.surg.2014.12.028.
    1. Gutnik LA, Yamey G, Dare AJ, et al. Financial contribution to global surgery: an analysis of 160 international charitable organisations. Lancet. 2015;385:S52. doi: 10.1016/S0140-6736(15)60847-9.
    1. Gutnik L, Dieleman J, Dare AJ, et al. Funding allocation to surgery in low and middle-income countries: a retrospective analysis of contributions from the USA. BMJ Open. 2015;5:e008780. doi: 10.1136/bmjopen-2015-008780.
    1. Kiaga AK, Lapeyre F, Marcadent P. The impact of COVID-19 on the informal economy in Africa and the related policy responses. Geneva: International Labour Organisation; 2020.
    1. Navarro S, Sibiya A, Nourian M, et al. Addressing supply chain management issues in cost-effective maternal and pediatric global surgery: a call to action. Int J MCH AIDS. 2020;9:77–80. doi: 10.21106/ijma.295.
    1. Global Health Supply Chain Technical Assistance—South Africa (2019) USAID USAID global health supply chain program
    1. Feinmann J. PPE: what now for the global supply chain? BMJ. 2020 doi: 10.1136/bmj.m1910.
    1. Shokrani A, Loukaides EG, Elias E, Lunt AJG. Exploration of alternative supply chains and distributed manufacturing in response to COVID-19; a case study of medical face shields. Mater Des. 2020;192:108749. doi: 10.1016/j.matdes.2020.108749.
    1. Truché P, Shoman H, Reddy CL, et al. Globalization of national surgical, obstetric and anesthesia plans: the critical link between health policy and action in global surgery. Glob Health. 2020;16:1. doi: 10.1186/s12992-019-0531-5.
    1. The Global Surgery Foundation (2020) Postponed: high-level workshop on national surgical obstetrical and anaesthesia planning in Nepal
    1. USAID Global Health Supply Chain Program . Best practices in supply chain preparedness for public health emergencies. Washington: USAID; 2019.

Source: PubMed

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