Concept note

The role of surgery in achieving universal access to Health Care has been highlighted in 2015 through a number of key activities. In  April 2015 the Lancet Commission on Global Surgery (LCoGS) was published. In May 2015 the World Health Assembly passed the resolution 68.15, Emergency and Essential surgical Care and Anesthesia (EESC&A). The World Bank published the 3rd version of the Disease Control Priorities (DCP3) with a whole volume dedicated to surgery.


In February 1st-3rd 2017, in Addis Ababa (Ethiopia), the Pan African Association of Surgeons (PAAS) has organized an international conference in collaboration with the African Union Commission (AUC) on “Global Surgery Implementation in Africa”. As surgical providers and from the perspective of development and socio-economic growth in line with the African Union agenda in 2063, 2024 STISA, Lancet commission key messages on global surgery, and WHO resolution, a PAAS action-plan has been adopted. Key messages from this conference were to place a responsibility of all of us to integrate surgery into the Primary Health Care Model; to ensure a relevant global surgery implementation in Africa through specific and concrete actions for: expanding access to safe, high quality, affordable surgery and anesthesia, particularly in rural and under-served areas; appropriate workforce training and education; health system strengthening including infrastructure development and financing; and research for essential surgical and anesthesia care.

Common to all of these activities is a recognition that, in the words of Jim Yong Kim President of the World Bank, “Surgery is an indivisible, indispensable component of health care.” Surgery has an essential role to play in preventing death and disability and improving the health of communities.

For far too long surgery has been considered to be an inefficient and expensive treatment modality with limited impact on communities. What has now been recognized is that in LMIC’s, there is a significant unmet need with regards to surgically treatable conditions. The consequence of this is an increased burden of disability and increased poverty. It has been estimated that up to 15% of all deaths are due to surgically preventable conditions. Adequate access to Surgical Care has the potential to enhance the economies of LMIC’s

The epidemiological shift from communicable to non-communicable diseases is intricately linked to the need for surgical care. Surgery, unlike treatment specific diseases, is a treatment system that requires a team approach and requires procurement and maintenance functions to ensure its efficiency.

The LCoGS identifies Health System Strengthening as a key priority area. The development of the District Hospital is crucial to increased delivery of surgical services. The challenge is to identify the basket of care package and key surgical competencies necessary as determined by the burden of disease. Without adequate skills development, having functional district hospitals will not meet the needs determined by the burden of disease.

To meet the need for surgery requires a significant increase in surgical care providers. The ability to realize this in the medium term is limited and as such we need to look for alternative options. This may include task sharing, something the PAAS in association with surgical Colleges and the Academic Health Sciences Faculties must engage with. However convincing the profession that this is a viable solution which is safe and effective will require significant effort. A competency based approach to developing surgical skills is essential in ensuring that a practionner who can do a caesarian section can also do a laparotomy for a perforated hollow organ and manage a complex fracture. Therefore, PAAS has decided to invite all health practitioners in Africa and all over the world for a 2nd edition international conference on Global surgery implementation in Africa to gather in Addis Ababa, in February 2018 and to share their different experiences on Global Surgery; in fact, the PAAS in association with AUC, WHO and the World are ready to start work towards African Union Agenda 2063, SDGs and UHC of EESC&A; after the PAAS action-plan adoption, this conference to come could be the second step to mobilize all global surgery expertise, health human resources in and outside Africa: individuals such as surgeons, obstetricians and gynecologists, anesthesiologists, public heath care providers, nurses, health technicians, scientific societies, surgical colleges and other training institutions for moving forward the implementation for the global surgery Agenda in Africa .

So far, PAAS next conference 2018 will focus on specific objectives as follows:

  1. Mobilize health care providers from all over the World and from all specialties involved in Global Surgery for Africa
  1. Raise awareness among AU, WHO, UNECA, Governments, African Ministers and Policy Makers in Health in Africa countries for establishment of a national and a continental agenda for global surgery.
  2. Sensitize African Ministers of Finance to support global surgery development process.

Prof KH Yangni-Angate, President PAAS


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