Surgery and universal health coverage: Designing an essential package for surgical care expansion and scale-up

Five billion people worldwide lack access to safe, timely, and affordable surgical and anaesthesia care, resulting in over 18 million deaths each year and one-third of the global burden of disease. In 2015, the World Health Organization and the Member States recognised surgical and anaesthesia care as a component of universal health coverage (UHC). National Surgical, Obstetric, and Anaesthesia Plans (NSOAPs) are long-term, strategic plans being developed by several low- and middle-income countries to strengthen emergency and essential surgical services by embedding within the government’s broader plans to implement UHC. Crucial, however, is the need for countries to define which surgical services should be included in essential health service packages. An approach that prioritises populations with the greatest need is vital for achieving financial risk protection and equity in global health. NSOAPs uniquely cross-cut health systems, allowing for the convergence of emergency and essential surgical care with other essential health services to meet broader UHC objectives.

How should surgical care (including obstetrics and gynaecology, anaesthesia, and the whole surgical ecosystem) be integrated within universal health coverage (UHC)? What surgical procedures should be included in essential health care packages? Who will receive such services? Who will pay? These are some of the questions that confront governments seeking to improve surgical care through UHC. These questions are not only daunting from a health systems perspective but also because of the scale of governmental challenges in increasingly uncertain political, economic, and socio-cultural contexts. The third Sustainable Development Goal (SDG Target 3.8) identifies UHC as a target for countries to attain by 2030 [1]. Surgical care is an integral component of UHC [2]: one-third of the global burden of disease, it is estimated, requires surgical intervention; 18 million people die from surgically treatable conditions annually [3]; and an additional 4.2 million die within 30 days of a surgical procedure each year [4,5]. There is an imperative to provide access to safe, timely, and affordable surgical services as part of UHC to achieve equity in global health systems.