Global Standards

More than 30% of the global health burden is due to diseases requiring surgical treatment1

The Need for Global Standardization in “Essential” Surgical Procedures

For decades, global health initiatives have overlooked this statistic and neglected to implement universal training standards for basic surgical treatments. This lack of standardization is felt most significantly in nations with the lowest performing health indicators: low- and middle-income countries (LMICs).

In wealthy nations, easy access to commonly performed procedures such as a Cesarean Section or appendectomy are expected by the population. But over 95% of the population in LMICs lack access to basic surgical care. This means as many as 4.8 million people worldwide are unable to obtain a simple, life-saving procedure.

In March 2015, the World Bank released a financial analysis which found that investments in a small number of basic surgical procedures would be highly cost effective and could save more than 1.5 million lives per year. The report included a list of 44 “essential” surgical procedures in a variety of disciplines2. However, in order to ensure universal access to these basic procedures, appropriate and adequate training must be universally available to surgical clinicians.

A small number of medical centers exist in Africa and other developing regions to provide care for conditions such as obstetrical fistula, cleft lip and palate, prostatic hypertrophy, and vaginal and urinary bladder prolapse. The current capacity to treat and train more doctors is overwhelmed by the volume of cases in need. Furthermore, such treatments are challenging and medically complex. Until recently there were no texts or even written standards of treatment. As such, unique and advanced training methods must be developed to implement this curriculum.

There is an immediate need to increase the number of appropriately trained, qualified health professionals in LMICs.

Cost-efficient, advanced training methods must be developed to administer the innovative curriculum required to meet this need.

Case Illustration: Obstetrical Fistula

Obstetrical fistula is one such can disorder that can be remedied by access to surgical care. It is a common and demeaning affliction of an estimated 3.5 million young women, with approximately 150,000 new cases occurring annually3. The existing capacity to treat these women is at barely 14,000 cases per year. Given these numbers, it is clear that the backlog of cases is too overwhelming to be effectively managed given the current resources.

Traditional hands-on surgical training at the global, regional, and local levels is both costly and time intensive. Even with proper training, many medical providers lose confidence and often stop repairing fistula upon returning to their home institution. Trainees need more efficient, higher quality, and access to follow-up and advanced training in order to provide safe, effective and sustained fistula surgical care within their communities.

Without treatment these women are often homeless, unable to live normal lives and interact with their families, maintain employment or play an active role in their community.

The existing capacity to treat obstetrical fistula cases in LMICs is less than 10%.

  1. The Lancet Commission on Global Surgery. Volume 386, No. 9993, p569–624, 8 August 2015.
  2. “Essential Surgery” Vol. 1, World Bank. Disease Control Priorities, 3rd edition. 2015.
  3. Wall, L.L., J.Wilkinson, S.S. Arrowsmith, O.Ojengbedee, and H. Mabeya. 2008. “A Code of Ethics for the Fistula Surgeon. International Journal of Gynecology and Obstetrics 101 (1):84-87.