Surgical care plays an essential role in strengthening health systems in resource-poor settings around the world. Diseases that are treatable through surgery—such as cancer, trauma, infections, congenital anomalies, and complications from childbirth—account for 11 to 25 percent of the global burden of disease, according to the World Health Organization (WHO). However, 2 billion people around the world have no access to emergency or surgical care.

The poorest third of the world receives less than 4 percent of the world’s available surgical services, while the richest third receives nearly 75 percent, reports the WHO. In Haiti’s Central Plateau, for example, there are only two orthopedic surgeons in an area that is home to more than 500,000 people and where a large proportion of emergency room visits are due to acute work-related injuries or trauma from traffic accidents or other sources.

Untreated surgical disease has an immense human, societal, and economic impact. For example, a disabled parent who doesn’t have access to safe surgical care may not be able to care for his or her family—a tragedy for the parent, the family, and society. As a result, the true economic impact of surgical disease that goes untreated can profoundly affect a country.

In poor countries, surgical care remains limited despite its cost-effectiveness. With growing evidence of the need for safe surgical care and its positive economic benefits to a society, surgery can no longer be considered a privilege for the few. Improving care delivery, education, training, and research within global surgery and anesthesia must be a key priority in global health.

PIH's response

To that end, PIH is involved in the launch of The Lancet Commission on Global Surgery, a new initiative that aims to ensure all people have access to safe, high-quality, affordable surgical and anesthesia care. Officially launched in December 2013 with an introductory comment in The Lancet, implementers of surgical services and health and policy experts will team up to find the best strategies for providing surgical care with a focus on low- and middle-income health systems.

Surgical interventions in PIH’s sites include orthopedics, otolaryngology (ear, nose, and throat), plastics, pediatrics, urology, OB-GYN, and general surgery. In Haiti, for example, Partners In Health helped provide 2,700 surgical operations across six facilities during the first half of 2012. To continue to improve care and expand the ability to respond to surgical disease, PIH offers surgical training programs including expert mentorship in and outside operating rooms in PIH sites, and trainings for local surgeons in top U.S. medical institutions.

The collaboration between our local surgical teams and international researchers—through the Paul Farmer Global Surgery Fellowship and the Global Health Equity Residency in General Surgery—help us mutually examine the surgical system in our sites. Building the skills of our local surgeons and research on how to improve surgery in resource-limited settings strengthens advocacy efforts for equity in surgical services.

Advancing surgical services strengthens the entire team of nurses, anesthetists, surgical and sterilization technicians, and logisticians across the health system and leads to high-quality, equitable care.