“Are we providing the right care, in the right way, at the right time, every time? Asked Dr Atul Gawande, who was confirmed this month as Deputy Administrator of the Bureau of Global Health at the United States Agency for International Development (USAID). He answered his own question about the complexities of delivering health care in the United States with a strong “no”.
With his new role, we propose to expand Dr Gawande’s claim, because the answer to his question only makes sense if we can provide this care everywhere..
Many know Dr Gawande as a surgeon, and from a surgical point of view alone, the challenges facing the delivery of healthcare around the world are daunting.
Trauma, the leading cause of disability and death among 5-14 year olds, is expected to kill 9.8 million children by 2030.
Under current health care funding regimes, 81 million every year people face financial catastrophe just by seeking surgical care.
These overwhelming statistics are expressed in surgical terms, not only because a surgeon will lead global health efforts at USAID, but because we believe the ability to perform surgery is the strength of a healthcare system. .
USAID Campaign Announcement Vision for health system strengthening 2030 affirms the organization’s position “that integrated and systems-based approaches to strengthening health systems are now more critical than ever”. With his confirmation, Dr Gawande will seek to turn this vision into reality.
Almost a third of sickness the burden in the world is surgical – if health systems are to be fully strengthened, USAID’s vision must include safe, timely and affordable surgical care.
The task of “strengthening health systems” is complex, with multiple components requiring improvements in concert with one another. Broaden the scope of first aid can lead to larger provider capacity and earlier detection of disease, and potentially provide basic surgical services without the need for an operating room.
Revitalized community clinics in Cuba provided additional access to primary care and an improved range of specialist services. Investments in technology transfers between clinics and specialist hospitals enable providers in rural clinics to offer basic trauma care, obstetrics and gynecology services, and even minor surgical procedures.
Malawi faces critical situation shortage of orthopedic surgeons and offers care by providers of different levels of training. Orthopedic clinical officers, who received some training but did not attend medical school, showed no difference in outcomes after major amputations and open reductions compared to fully trained surgeons.
These results suggest that some conditions can be safely treated by providers with a shorter training time leading to a faster expansion of the surgical workforce. While not a perfect solution, it will help low-income countries move closer to the multiplied by twenty in the labor density required to meet minimum recommendations.
An investment in surgical systems will not only improve outcomes for surgical patients. The personnel, space, and supplies necessary to perform surgery are required in many areas of medicine.
The COVID-19 pandemic demonstrates the cross-cutting capacity of surgical resources expand the capacity and resilience of health systems in times of immense crisis.
Hospitals Overwhelmed by COVID-19 Patients Display Incredible Flexibility in Converting operating theaters in intensive care units and anesthesia machines in intensive care ventilators. In the face of widespread case cancellations, surgeons, anesthesiologists and staff continue to volunteer as a highly skilled workforce ready to help with the deluge of COVID-19 patients.
Stronger health systems come with better access to surgical care, and improved access to surgical care strengthens health systems. This synergistic relationship makes it possible to optimize resources and provide care for the entire spectrum of the disease.
If Dr Gawande and USAID’s vision is truly to strengthen health systems, then surgical care must be a indivisible and indispensable part systems that we hope to build. This hope is based on the fact that every day we have the opportunity to improve the lives of billions of people. This is the real vision; to make the world a better place.
John Meara, MD, DMD, MBA, is Chief Plastic Surgeon at Boston Children’s Hospital and Kletjian Professor of Global Surgery at Harvard Medical School, where he leads the Global Surgery and Social Change program. @johnmeara
Geoffrey A. Anderson, MD, MPH, is an associate surgeon at Brigham and Women’s Hospital, a faculty member at Harvard Medical School, and a faculty member in the Global Surgery and Social Change program. @GeoffAndersonMD
Matthew T. Hey is a Research Associate in the Global Surgery and Social Change Program at Harvard Medical School. @Mattt_Hey