A Financing Strategy to Expand Surgical Health Care

National Surgical Healthcare Policy Development and Implementation: Where do We Stand in Africa?

BACKGROUND

National surgical policies have been increasingly adopted by African countries over the past decade. This report is intended to provide an overview of the current state of adoption of national surgical healthcare policies in Africa, and to draw a variety of lessons from representative surgical plans in order to support transnational learning.

METHODS

Through a desk review of available African national surgical healthcare plans and written contributions from a committee comprising six African surgical policy development experts, a few key lessons from five healthcare plans were outlined and iteratively reviewed.

RESULTS

The current state of national surgical healthcare policies across Africa was visually mapped, and lessons from a few compelling examples are highlighted. These include the power of initiative from Senegal; regional leadership from Zambia; contextualization, and renewal of commitment from Ethiopia; multidisciplinary focus and creation of multiple implementation entry points from Nigeria; partnerships and involvement of multiple stakeholders from Rwanda; and the challenge of surgical policy financing from Tanzania. The availability of global expertise, the power of global partnerships, and the critical role of health ministries and Ministers of Health in planning and implementation have also been highlighted.

CONCLUSIONS

Strategic planning for surgical healthcare improvement is at various stages across the continent, with potential for countries to learn from one another. Convenings of stakeholders and Ministers of Health from countries at various stages of strategic surgical plan development, execution, and evaluation can enhance African surgical policy development through the exchange of ideas, lessons, and experiences.

How should we prioritise global surgery? A capabilities approach argument for the place of surgery within every health system

In the rapidly evolving landscape of global health issues and policy, surgery has historically been sidelined due to concerns about high cost, complexity and other concerns including quantitatively less surgical disease burden in comparison to infectious disease or other health conditions. Now, in the context of pandemics, climate change, shrinking health budgets and other global health security concerns, the hard-won progress in raising the profile of surgical care is at risk, and a reconceptualisation is needed to maintain its position in global healthcare agendas. We challenge the long-standing ethical frameworks that underlie healthcare priority setting, namely cost-effectiveness analysis and human rights, that have contributed to surgery being sidelined for decades. They incompletely account for improvements to life quality and well-being that are possible through surgical healthcare systems. We argue for the Capabilities Approach as an alternative normative framework because it emphasises the moral importance of supporting every person's abilities to be and to do the things they value. Through this framework, we can produce a more comprehensive conception of healthcare that goes beyond biomedical health, and surgical healthcare would ultimately gain a higher priority in valuation of healthcare and non-healthcare interventions.