Expanding access to safe, high quality, affordable surgery and anaesthesia, particulary in rural and under-served areas

Service delivery



Responsible body

Surgical volume; system coordination; quality and safety safety

  • All first-level hospitals should provide laparotomy, caesarean delivery, and open-fracture treatment (Bellwether Procedures)

  • Promote functionning referral system for district hospitals to refer up and communication networks with higher level specialists

  • Establish a common definition of 1st level hospitals and agree on the list of surgical procedures to be carried out at this level.

  • Establish checklist/criteria/minimum requirements for delivering agreed set of surgical procedures at 1st level hospitals.

  • Assess capacity of 1st level hospitals (public and private) to carry out agreed surgical procedures according to the above checklist.

  • Build the capacity of 1stlevel hospitals according to the identified gaps.

  • Establish a common M&E framework for assessing the performance

  • Establish measures and indicators for quality improvement

  • PAAS committee and national focal points (from Ministry of health and social welfare)/National central Statistics department /Regional Surgical colleges/Regional quality assurance bodies

  • WHO and Health Matrix Networks for technical support

  • Integrate public and private NGO providers into common national delivery framework; promote demand-driven partnerships with NGOs to build surgical capacity

  • Develop/revise legal and regulatory frameworks to facilitate integration of public and private health practices.

  • Identify potential and active partners in healthcare and Create alliances/agreements with multilateral and bilateral global, regional and local public and private health care instructions which can supply affordable, sustainable and minimum condition of services (supplies, technology, equipments, and skills/trainings etc, share best practices).

  • Establish national Health Insurance system and negotiate with private health service providers to participate at reduced cost

  • PAAS committee

  • Focal points , bilateral/multilateral agencies and NGOs for active negotiations

  • Prioritise health-care management training

  • Develop and implement a costed HRH training plan.

  • Develop and implement health care specific (including surgical care ) curriculum and training modules

  • Establish HCW exchange programs to foster/share knowledge and best practices.

  • Conduct periodic assessment of impact of trainings on quality of care through supportive supervision and operational research

  • PAAS committee

  • AU department of HRST and PAU


  • Prioritise quality improvement processes and outcomes monitoring

  • Promote appropriate surgical workforce and regional specialists

  • Agree and establish quality improvement indicator list and build capacity of health care system to achieve them.

  • Develop and institutionalize tools for quality assessment.

  • PAAS/National Focal points

  • WHO

  • AU DSA

  • Promote telemedicine to build system-wide connectivity

  • Promote system-wide connectivity for telemedicine applications, clinical support and education

  • Identify and use ICT tools for on –the job training of HHR.

  • PAAS committee

  • AU economic affairs/ African telemedicine program./AU DHRST

  • Virtual universities/PAU


 Appropriate workforce, training and education




Responsible body

Surgical, anaesthetic, and obstetric providers; allied health providers (nursing, operational manager, biomedical engineers, and radiology, pathology, and laboratory technician officers)

  • Establish training and education strategy based on population and needs of country

  • Require rural component of surgical and anaesthetic training programmes

  • Require training program in remote hospitals where training can take place

  • Training an education strategy of surgeons,O&G,anesthetics and ancillary staff based on Essential and Emergency surgeries as defined by WHO

  • Accreditation of regional surgical training centres

  • Accreditation of Regional Surgical Skills centres

  • Conduct surgical human resource need assessment for rural and urban segments and use the information to advocate for training and education strategy development .

  • Establish or Build capacity of existing local and regional health/medical training institutes to train HCW at affordable and sustainable cost.

  • Set standards on the numbers and mix of staff, distribution and competencies.

  • Promote on the job –practical trainings for midlevel health work force to adapt /adopt task-shifting approach.

  • Conduct regular, integrated and coordinated supportive supervision of surgical workforce to develop and maintain their skills.

  • PAAS committee/National Ministry of higher education/Ministry of Health and Social Welfare


  • WHO for technical support

  • Develop a context-appropriate licensing and credentialing requirement for all surgical workforce

  • Develop a context-appropriate licensing and credentialing requirement for all surgical workforce

  • Establish criteria for and mechanisms to assess and ensure surgical workforce licence retention

  • PAAS committee/PAU and National Focal Point

  • Invest in professional health-care manager training and in a mandatory continuing professional development via workshops,Seminars,Skills courses and Simulation

  • Collaborate and create partnership with management training institutions (including public administration, healthcare administration, business) and with Surgical Colleges or other professional training institutions to facilitate provide .

  • Work with IT sector to develop online learning portal for health-care managers

  • Implement a performance based promotion for professional and all HCW at various levels

  • PAAS/PAU/ National Ministry of higher education/MOHSW

  • AU-DSA and DHRST

  • WHO for technical support

  • Establish biomedical equipment training programme

  • Define and purchase biomedical equipment for delivering quality health care

  • Train and supervise biomedical staff to ensure patients safety and equipment longevity

  • Establish equipment inventory system and preventive maintenance plan.


Health system strengthening including infrastructure development and financing




Responsible body

Surgical facilities; facility readiness; blood supply; access and referral systems

  • Track number and distribution of surgical facilities

  • Agree on the definition/criteria of a “surgical facility”

  • Conduct a nationwide survey to determine the number, location and capacity of “surgical facilities” in each country

  • PAAS/National Focal Points

  • Regional Surgical Colleges

  • AU-PAU and DSA

Resuscitation services for trauma,obstetric care and emergency surgical cases

  • Districts to establish the surgical and anaesthetic equipment and supplies need and create a corresponding budget line

  • Integrate the surgical equipment/supplies need to the existing district health supply chain system.

  • PAAS/MOHSW/National Focal Points/Ministry of Finance

  • Equip first-level surgical facilities to be able to do laparotomy, caesarean delivery, and treatment of open fracture (the Bellwether Procedure) and to have access to rehabilitation services

  • Primary Health Facilities should work with surgeons and anaesthetists referral hospitals to establish the requirements (staff, equipment, drugs, infrastructure etc) for conducting agreed surgical procedures.

  • Develop plan and Establish budget for meeting the surgical and anaesthetic requirement s of priority surgical procedures ( trauma, obstetric procedures ,emergency surgical cases and laparotomy) and for access to rehabilitation services

  • Use the existing supply chain system to purchase the required commodities.


  • ADB

  • Develop national blood plan

  • Collaborate with other programs (eg infectious disease prevention and control program, biomedical laboratories, pharmaceutical companies, local and international NGOs eg Red cross/Red crescent, local communities) to improve or develop safe blood program.

  • Work with media and use various platforms (eg sports, commemoration and celebration events, educational) to promote blood donation.

  • PAAS/MOHSW/ ministry of information and sports for leading role

  • African CDC/AUDSA

  • Red cross/crescent

  • MSF

  • Reduce barriers to access through ambulances,good roads,electricity and water supplies and enhanced connectivity across entire care delivery chain from community to tertiary care

  • Establish referral systems with community integration, transfer criteria, referral logistics, and protection for first responders and helpful members of the public

  • Involve community influential leaders ( religious, traditional, business, political figures) to promote healthcare seeking behaviours.

  • Promote community healthcare workers to educate and refer patients to HC facilities.

  • Use the advantage of IT eg mobile phones (toll free emergency help line) to provide health information and education and promote service utilization and referral.

  • Establish a reliable transport system and command chain for emergency cases

  • As much as possible countries should establish a national health insurance to minimize out of pocket payment

  • Where cost sharing is applicable, countries should establish waver system to ensure equitable access to care.

  • PAAS/National focal point

  • AU-Infrastructure and energy

  • ADB-financing

  • WHO-technical support




Health financing and accounting, budget allocation

  • Cover basic surgical packages with universal health coverage

  • Review/develop essential health care package to cover basic surgical services.

  • PAAS/ MoF/MOHSW-leading role

  • ADB –Financing


Research for essential surgical and anaesthetic care

 Information Management



Responsible body

Information systems; research agenda

  • Develop urgently a robust information systems to monitor clinical processes, cost, outcomes, and identify deficits at an African Continental Level

  • Develop database / integrated Medical Record System

  • Build capacity of HCW to collect, analyse, disseminate and utilise health system data for planning and improvement of service delivery..

  • PAAS/National Focal Points

  • AU DHRST/PAU/Regional surgical colleges

  • WHO/Health Matrix Networks

  • Identify, regulate, and fund surgical research priorities of local relevance

  • Work with academia to develop /improve capacities of HCW to conduct health and related research

  • Establish /improve health research in collaboration with existing research networks

  • Identify and collaborate with local and international health program such as Bill& Melinda, CHAI etc) for research funding.


  • PAU


  • Africa CDC




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