Explained: Surgery is not for the poor

First authors: John G Meara, Andrew JM Leather, Lars Hagander

The Lancet Commission on Global Surgery was planned in September 2013 with the aim of defining the global surgery landscape, reviewing best practices, suggesting ways forward. Now, for the first time, global surgery has a strong evidence base to describe the discipline and act as motivation for change.

The development and delivery of surgical and anaesthesia care in low-income and middle-income countries (LMICs) has been nearly absent from the global health discourse. To address the gap, an international multidisciplinary team of 25 commissioners spent 18 months interacting with hundreds of people in 11 countries across all six continents. Five key messages of the study:

♦ 5 billion people — nearly 70 per cent of the global population of 7.2 billion — lack access to safe, affordable surgical and anaesthesia care. 97% of the population of South Asia and 93% of sub-Saharan Africa can’t access basic surgical care.

♦ Conservatively, 143 million more surgical procedures are needed each year to save lives, prevent disabilities. South Asia, of whose population India has the biggest chunk, has an unmet need of 3,582 surgical cases per 1 lakh population each year.

♦ 33 million individuals face catastrophic health expenditure due to surgery and anaesthesia each year. Most are poor, and live in sub-Saharan Africa and South and Southeast Asia.

♦ Investment in surgical and anaesthesia services is affordable, saves lives, and promotes economic growth. Disease affects labour supply and capital stock, which are, in turn, related to GDP over time.

♦ Surgery is an indivisible and indispensable part of healthcare. More than 1 lakh maternal deaths can be averted by timely intervention. Increased access to caesarean delivery reduces neonatal mortality by between 30% and 70%.