Surgical care in the public health agenda

Abstract

The Access to surgical care has been neglected and unrecognized as a public health problem 1 . Recently, however, it has been incorporated into the global health research agenda, resulting in a growing knowledge base of how surgery can be incorporated into health policy 2,3 . The Lancet Commission on Global Surgery published a report in 2015 that frames the provision of surgical care as an essential part of health systems. The report advocates for the prioritization of surgery and the integration of principles of universality, equity, and justice into surgical systems. Furthermore, the report emphasized the economic argument that surgical care is cost-effective, even in areas of limited resources 2 .Scientific advances in surgical care -which include both an evolution in procedures and incorporation of new technologies -have improved the diagnosis and treatment of health problems. Yet, these advances have not been shared across different health systems, regions, or socioeconomic groups. In many countries and localities, access to surgical care is limited by the scarcity of surgeons, anesthetists and obstetricians 4,5 . Nearly 5 billion people worldwide do not have access to safe, affordable, and timely surgical care, and only 6% of total surgical procedures occur in the world's poorest countries. Moreover, it is estimated that 16.9 million lives were lost in 2010 due to health problems that required surgical care 6 . Surgical disease manifests across all age-groups and affects the care of many conditions that are prioritized in public health. It plays a critical role in trauma, maternal and child health, and cancer; ultimately, surgery is estimated to play a role in 28-32% of the global burden of disease 7 .The unavailability of timely surgical care can transform treatable conditions into diseases with high mortality and morbidity, besides adversely affecting the economy of countries and the wellbeing of populations 8 . For laboring women, unresolved surgical complication can lead to the death of mother and child; congenital malformations, such as cleft lip, and acquired conditions, such as burns, if left uncorrected, can harm the cognitive and social development of individuals; and delays in trauma care and fractures can leave young people disabled and economically unproductive for life.The surgical system is ample and includes professionals, institutions, as well as public and private financial sectors responsible for service delivery. The surgical system is involved across the spectrum of disease, ranging from prevention to diagnostics to treatment and palliation. It requires human resources, consumables and equipment, which are used in the preoperative evaluation of patients' health and risk factors, the intraoperative period during which procedure occurs, and the postoperative period. To this end, the surgical system requires infrastructure consisting of surgical facilities, blood supply, referral systems as well as human resources capable of anesthetic, surgical and obstetric care. This includes ph...

Cirurgia Pediátrica Na Saúde Pública

“…O SUS, direito garantido a qualquer cidadão brasileiro, utiliza um modelo baseado na hierarquização das ações e serviços de saúde por níveis de complexidade (SCHEFFER et al, 2017). A atenção primária, que é formada pelas unidades básicas de saúde, equipe de saúde da família e núcleo de apoio à saúde da família, é responsável por procedimentos de baixa complexidade bem como promoção e prevenção da saúde (SCHEFFER et al, 2018). Há também o nível secundário de atenção, que inclui clínicas, unidades de pronto atendimento e hospitais de ensino, responsáveis por ações como exames mais complexos ou tratamento de doenças agudas ou crônicas.…”

“…Por fim, o nível terciário de atenção é composto por hospitais de alta complexidade, que atendem pacientes com casos mais graves e de maior risco. Essa classificação permite que casos menos urgentes não ocupem desnecessariamente vagas em centros mais especializados, o que possibilita um atendimento mais direcionado aos pacientes de acordo com suas reais necessidades, tornando o sistema mais eficiente (SCHEFFER et al, 2018). Além disso, como o sistema de saúde promove não apenas o tratamento, mas também a prevenção de doenças e agravos, há uma redução nos gastos do estado com saúde, pois a prevenção tem um custo menor e evita tratamentos que seriam necessários se não ocorresse, além de contribuir para a saúde da população.…”