Looking Beyond Physician Surgeons: How to Build Capacity for Global Safe Surgery

Imagine being unable to access surgical treatment for life-threatening and disabling conditions like an emergency Caesarian section, maternal hemorrhage, congenital abnormalities, breast and cervical cancer, and others. This is the unfortunate reality for 5 billion people globally who lack access to safe surgery. Though this would never be acceptable in the United States or other developed nations, it's one of the most critical problems people in low and middle-income countries (LMICs) face today.

The World Health Organization's (WHO) March bulletin dissected global disparities in access to safe surgery. Despite the fact that surgery is on the rise globally, only 30% of these operations were performed in LMICs - where 71% of the world's population resides.

The inaccessibility of safe surgery is particularly evident in the context of maternal and child health. Although emergency obstetric services account for nearly 30% of all procedures in low-expenditure settings, in Africa, only 6% of maternal wards have proper anesthesia training for Caesarian section or post-partum hemorrhage treatment.

These numbers are daunting, and collaborative action must be taken to address the unmet needs of the surgical ecosystem. The BMJ outlines a roadmap for this in its recently published paper, which details how universities, hospitals, biotech companies and others can address challenges that prevent access to safe surgery - one of the most pressing being lack of trained surgeons.

With an overwhelming shortage of 2.5 million surgeons globally, we cannot hope to train physicians fast enough without losing lives along the way. To create a better surgical ecosystem, it's critical that we look beyond the physician surgeon - the nucleus of the operating room - and build the capacity of the entire network of providers, including anesthetists, equipment technicians, and nurses, to bolster the delivery of quality care.

Worldwide, nurses provide 90% of health care services. According to the WHO, in countries such as Malawi and Mozambique, non-physician surgeons provide 85-90% of Caesarean sections, obstetric hysterectomies and laparotomies for ectopic pregnancy. Clinical officers also play a vital role in surgical care by providing services that, in other countries, fall under the purview of physician surgeons. These non-physician providers are the key that will unlock the full potential of the surgical ecosystem. It's our collective responsibility to ensure they have the right skills to provide safe surgical treatment.

Of course, this cannot be done alone. The GE Foundation is fortunate to have strong international, cross-sector partners, like Jhpiego, Assist International, the G4 Alliance and Dalberg, who help us make a greater impact and build the capacity of the many contributors to the health system. Our efforts are also fueled by leading academic institutions, which have provided a rich framework for our initiatives. For instance, the work of Harvard-based Dr. John Meara and Mark Shrime, whose Lancet report and editorials in The New York Times and, more recently, the Los Angeles Times (with Nakul Raykar), shed attention on the importance of safe surgery through the lens of the global development agenda and the United Nation's (UN) new Sustainable Development Goals, remains indispensable to our work in the U.S. and abroad.

During last year's UN General Assembly, we launched Safe Surgery 2020, an initiative to increase access to safe surgery in underserved areas by building leadership on the ground, testing and scaling innovation, and elevating safe surgery's profile on the global stage. Together with our partners, the GE Foundation will continue to build on this commitment to build capacity and improve the quality of surgical treatment at scale.

I am confident that we can build a better ecosystem for safe surgery, which the world needs now more than ever before. To accelerate progress achieving this, the public and private sectors must take collaborative action, provide training, and commit to building surgical capacity for non-physician providers. This will begin to address the dire need for access to safe surgery on a global scale and will save the lives of millions of individuals, strengthen local communities, and ultimately create sustainable health systems.