Increasing Access to Surgical Services in Sub-Saharan Africa: Priorities for National and International Agencies Recommended by the Bellagio Essential Surgery Group

Abstract

In this Policy Forum, the Bellagio Essential Surgery Group, which was formed to advocate for increased access to surgery in Africa, recommends four priority areas for national and international agencies to target in order to address the surgical burden of disease in sub-Saharan Africa.

Trends in caesarean delivery by country and wealth quintile: cross-sectional surveys in southern Asia and sub-Saharan Africa

“…23 Countries in sub-Saharan Africa generally have few skilled workers able to perform surgery -including caesarean sections -and most of their qualified doctors live in urban areas. 22,24 In the present study, caesarean delivery rates were extremely low among both the richer and poorer women who lived in rural areas, where structural and workforce constraints may be the most important barriers to access.…”

“…21,22 A recent study in Ghana, Kenya, Rwanda, Uganda and the United Republic of Tanzania -five countries included in our study -revealed massive gaps in the infrastructure for emergency surgical care. 23 Fewer than 50% of the hospitals surveyed had dependable running water and electricity, and only 19-50% of the hospitals provided 24-hour emergency care.…”

An estimate of hernia prevalence in Nepal from a countrywide community survey

“…[5,6] Investment in health priorities exclusive of surgery has left many poor countries unable to care for the growing burden of surgical diseases. [7][8][9] Deficient infrastructure, personnel, and equipment limit even basic surgical care. [6,10] Moreover, those in need of surgery face significant access to care barriers including: excessive distance to capable health facilities, poor roads, inability to afford care, fear and mistrust of the healthcare system.…”

Surgical epidemiology: a call for action

“…5 Similar achievements in the broader field of surgical epidemiology are feasible through analogous processes of consensus-building among stakeholders. Although these processes were initiated by activities such as the meetings of the Bellagio Essential Surgery Group, 3 the Disease Control Priorities Project report 1 and some recent publications, 11 much more needs to be done to establish the field of surgical epidemiology on a sound basis. ■ Competing interests: None declared.…”

“…2 Surgery can play a vital role in helping countries meet their Millennium Development Goals 4, 5 and 6. 3 To build a stronger case for surgery as part of the armamentarium of cost-effective interventions in developing countries, epidemiologists need to work alongside their surgical colleagues to develop the nascent field of surgical epidemiology.…”