Key messages from The World Bank Disease Control Priorities, Volume 1
Summary and analysis of the 5 main findings on essential surgery
The World Bank will publish the nine volumes of Disease Control Priorities, 3rd edition, in 2015–16. Volume 1—Essential Surgery—identiﬁes 44 surgical procedures as essential on the basis that they address substantial needs, are cost eﬀective, and are feasible to implement. This report summarises and critically assesses the volume’s ﬁve key ﬁndings. First, provision of essential surgical procedures would avert about 1·5 million deaths a year, or 6–7% of all avertable deaths in low-income and middle-income countries. Second, essential surgical procedures rank among the most cost eﬀective of all health interventions. The surgical platform of the ﬁrst-level hospital delivers 28 of the 44 essential procedures, making investment in this platform also highly cost eﬀective. Third, measures to expand access to surgery, such as task sharing, have been shown to be safe and eﬀective while countries make long-term investments in building surgical and anaesthesia workforces. Because emergency procedures constitute 23 of the 28 procedures provided at ﬁrst-level hospitals, expansion of access requires that such facilities be widely geographically diﬀused. Fourth, substantial disparities remain in the safety of surgical care, driven by high perioperative mortality rates including anaesthesia-related deaths in low-income and middle-income countries. Feasible measures, such as WHO’s Surgical Safety Checklist, have led to improvements in safety and quality. Fifth, the large burden of surgical disorders, cost-eﬀectiveness of essential surgery, and strong public demand for surgical services suggest that universal coverage of essential surgery should be ﬁnanced early on the path to universal health coverage. We point to estimates that full coverage of the component of universal coverage of essential surgery applicable to ﬁrst-level hospitals would require just over US$3 billion annually of additional spending and yield a beneﬁt–cost ratio of more than 10:1. It would eﬃciently and equitably provide health beneﬁts, ﬁnancial protection, and contributions to stronger health systems.
Mock CN, Donkor P, Gawande A, et al. Essential surgery: key messages from Disease Control Priorities, 3rd edition. The Lancet. 2015; http://dx.doi.org/10.1016/S0140-6736(15)60091-5.
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