Economic Impact of surgery on households and individuals in low income countries: A systematic review

Background
Surgical disease in Low Income Countries (LIC) is common, and overall provision of surgical care is poor. A key component of surgical health systems as part of universal health coverage (UHC) is financial risk protection (FRP) – the need to protect individuals from financial hardship due to accessing healthcare. We performed a systematic review to amalgamate current understanding of the economic impact of surgery on the individual and household. Our study was registered on Research registry (www.researchregistry.com).

Methods
We searched Pubmed and Medline for articles addressing economic aspects of surgical disease/care in low income countries. Data analysis was descriptive in light of a wide range of methodologies and reporting measures. Quality assessment and risk of bias analysis was performed using study design specific Joanna-Briggs Institute checklists. This study has been reported in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (Assessing the methodological quality of systematic reviews) Guidelines.

Results
31 full text papers were identified for inclusion; 22 descriptive cross-sectional studies, 4 qualitative studies and 5 economic analysis studies of varying quality. Direct medical, direct non-medical and indirect costs were variably reported but were substantial, resulting in catastrophic expenditure. Costs had far reaching economic impacts on individuals and households, who used entire savings, took out loans, reduced essential expenditure and removed children from school to meet costs.

Conclusion
Seeking healthcare for surgical disease is economically devastating for individuals and households in LICs. Policies directed at strengthening surgical health systems must seek ways to reduce financial hardship on individuals and households from both direct and indirect costs and these should be monitored and measured using defined instruments from the patient perspectiv

Investing in Surgery: A Value Proposition for African Leaders

Globally, poor access to high-quality surgical, obstetric, and anaesthesia care remains a main contributor to global disease burden accounting for about a third of deaths worldwide. The need for strengthening surgical care systems is especially urgent in sub-Saharan Africa, where access is strikingly limited, leading to the highest mortality and morbidity from surgically preventable and treatable conditions in the world. Approximately 93% of the population of sub-Saharan Africa lacks access to safe, affordable, and timely surgical care, compared with less than 10% in high-income countries.2 Despite the immense and growing need for surgical services in sub-Saharan Africa, investments by African public sector leaders to improve surgical systems on the subcontinent have been inadequate. The current COVID-19 pandemic has disrupted health care globally, with an estimation by the CovidSurg Collaborative showing that more than 28 million surgeries will be postponed or cancelled worldwide during the 12 weeks of peak disruption. There is a basic ethical responsibility to provide surgical care as a fundamental human right, in keeping with the principles espoused in the Universal Declaration of Human Rights. Additionally, improved access to high-quality surgical care is an essential component of universal health coverage and will contribute to good health and wellbeing, leading to improved human capital—all of which are vital for poverty reduction and economic growth on the continent.

Global aspects of cardiothoracic surgery with focus on developing countries.

The incidence and prevalence of cardiothoracic disease continue to increase globally, especially in emerging economies and developing countries. Cardiothoracic surgery is also growing despite limited access, availability of surgical centers, political and cost issues. The increase in atherosclerotic coronary artery disease, rheumatic heart disease, congenital heart disease, trauma, and thoracic malignancies is a more urgent problem than realized in these emerging economies and developing countries, or low- and middle-income countries. A determined focus and cooperation between the preventive and curative elements of care is warranted. This represents a paradigm shift to develop a consensus that fosters a multi-integrated disease-specific approach that includes prevention, promotion, diagnosis, treatment, and rehabilitation. In addition, the concept or acceptance of surgery as a necessary component of public health policy is critical to improving overall global healthcare.

Musculoskeletal trauma services in Uganda.

Approximately 2000 lives are lost in Uganda annually through road traffic accidents. In Kampala, they account for 39% of all injuries, primarily in males aged 16-44 years. They are a result of rapid motorization and urbanization in a country with a poor economy. Uganda’s population is an estimated 28 million with a growth rate of 3.4% per year. Motorcycles and omnibuses, the main taxi vehicles, are the primary contributors to the accidents. Poor roads and drivers compound the situation. Twenty-three orthopaedic surgeons (one for every 1,300,000 people) provide specialist services that are available only at three regional hospitals and the National Referral Hospital in Kampala. The majority of musculoskeletal injuries are managed nonoperatively by 200 orthopaedic officers distributed at the district, regional and national referral hospitals. Because of the poor economy, 9% of the national budget is allocated to the health sector. Patients with musculoskeletal injuries in Uganda frequently fail to receive immediate care due to inadequate resources and most are treated by traditional bonesetters. Neglected injuries typically result in poor outcomes. Possible solutions include a public health approach for prevention of road traffic injuries, training of adequate human resources, and infrastructure development.