Surgical Care at Rural District Hospitals in Low- And Middle-Income Countries: An Essential Component of Universal Health Coverage

Surgical care has long been considered too exclusive and uneconomical to be a public health priority, despite one third of the total global burden of disease being attributed to surgical conditions. Furthermore, five billion people worldwide do not have access to safe and timely surgical care, the majority of whom live in low- and middle-income countries (LMICs) including sub-Saharan Africa.
The Lancet Commission on Global Surgery has highlighted surgical care as an important component of universal health coverage, urging the world to make surgical, anaesthetic and obstetric services a priority on the global health agenda. In 2015, the World Health Assembly passed a declaration stating that timely and safe essential and emergency surgical care (EESC) was a key component of universal health coverage and that district hospitals should be the backbone of EESC. The World Bank further described 44 EESC procedures, 28 of which were categorised as district-level procedures. In order to achieve equitable access to EESC, strengthening surgical health systems, especially at the district level, requires prioritisation.