Emergency and essential surgical care

Surgery: the neglected component of primary care

More than 30 years ago, then Director-General of the WHO Dr. Mahler identified the important role of Surgery in primary health care, citing the availability of emergency surgical treatment in injuries as an essential component. "Without it, in spite of preventive measures…people will not have faith in primary health care…people in need must have access to skilled surgical care at the first-line referral hospitals. Yet the vast majority of the world's population has no access whatsoever to skilled surgical care and little is being done to find a solution."

Today, we know that approximately 2 billion people still have no access to basic surgical care.

Surgery continues to be the neglected component of primary care, perhaps due to common misconceptions.

Some people think Surgery… In reality…
addresses only a small part of the global burden of disease 11% of the global burden of disease can be treated with surgery
is not cost-effective surgical care in Africa is comparable to measles immunization (USD 32.78 vs. 30 per DALY* averted) (Gosselin, et al.)
can only be delivered by surgeons midwives in Mozambique perform most obstetric operations with good outcomes (Pereira, et al.)
cannot scale rural, resource-poor surgical programs in Haiti and Mongolia have been successfully scaled-up (Ivers, et al.)
is too complicated to set up and provide (need high-tech equipment) simple surgical procedures like circumcision to protect against HIV, and casting to correct clubfoot have been done on a large scale
can only be introduced after health systems have been strengthened building surgical services, infrastructure, and workforce CAN strengthen health systems

* Disability-adjusted life years, equal to one year of healthy life lost

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