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Surgical Care and Health Systems

  • Surgical Symposium Contribution
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Abstract

Background

While surgical care impacts a wide variety of diseases and conditions with non-operative and operative services, both preventive and curative, there has been little discussion concerning how surgery might be integrated within the health system of a low and middle-income country (LMIC), nor how strengthening surgical services may improve health systems and population health.

Methods

We reviewed reports from several meetings of the working group on health systems strengthening of the Global Initiative for Emergency and Essential Surgical Care, and also performed a review of the literature including the search terms “surgery,” “health system,” “developing country,” “health systems strengthening,” “health information system,” “financing,” “governance,” and “integration.”

Results

The literature search revealed no reports which focused on the integration of surgical services within a health system or as a component of health system strengthening. A conceptual model of how surgical care might be integrated within a health system is proposed, based on the discussions of our working group, combined with sources from the medical literature, and utilizing the World Health Organization’s conceptual model of a health system.

Conclusions

Strengthening the delivery of surgical services in LMICs will require inputs at multiple levels within a health system, and this effort will require the coalescence of committed individuals and organizations, supported by civil society.

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Acknowledgments

We thank Paulinus Sikosana for comments regarding the first version of this manuscript, as well as Jabbin Mulwanda who participated in one of our group discussions.

Conflict of interest

The authors include WHO staff, and the views expressed in this publication reflect their views and not necessarily that of WHO. The corresponding author (DS) has served as a consultant for the WHO.

Author information

Authors and Affiliations

  1. Division of Orthopaedic Surgery, Childrens Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, USA

    David A. Spiegel

  2. Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, USA

    Peter Bendix

  3. Department of Clinical Sciences in Lund, Paediatric Surgery and Global Paediatrics, Faculty of Medicine, Children’s Hospital, Lund University, 22185, Lund, Sweden

    Lars Hagander

  4. Health Policies and Service Delivery, Health Systems and Services Cluster, WHO Regional Office for Africa, Cite de Djoue, BP 06, Brazzaville, Republic of Congo

    Martin Ekeke-Monono

  5. Rady Children’s Hospital-University of California, San Diego, USA

    Stephen W. Bickler

  6. WHO Representative to Namibia, UN House, Klein Windhoek, Namibia

    Monir Islam

  7. Gender and Life Course, PAHO/WHO, P.O. Box 508, Bridgetown, BB11000, Barbados

    Beryl Irons

  8. Georgetown Public Hospital Corporation, New Market & Thomas Streets, North Cummingsburg, Georgetown, Guyana

    Sheik Amir

  9. Department of Surgery, Branch for International Surgical Care, Room 3129, 950 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada

    Robert Taylor

  10. West Coast Demerara, Guyana, South America

    Maya Layne

  11. Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03768, USA

    Sarah Crockett

  12. University of Utah, Suite 410, Salt Lake City, UT, 84107, USA

    Raymond R. Price

  13. World Health Organization, PO Box 7608, Nasr City, Cairo Egypt

    C. Omar Saleh

  14. Mayo Hospital, King Edward Medical University, 8 Golf Lane G.O.R.1, Lahore, 54000, Pakistan

    Syed Mohammad Awais

  15. University of Ghana, Accra, Ghana

    Dinah Baah-Odoom

  16. IGOT Institute for Global Orthopaedics and Traumatology, UCSF Orthopaedic Trauma Institute, 2550 23rd Street, Build 9, 2nd Fl., San Francisco, CA, 94110, USA

    Amber Caldwell

  17. Addis Ababa, Ethopia

    Helena Hailu

  18. Booz&Co, 7 Savoy Ct, London, WC2R Ojp, UK

    Mohit Misra

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  1. David A. Spiegel
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  2. Mohit Misra
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  3. Peter Bendix
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Consortia

Health Systems Strengthening Working Group of the Global Initiative for Emergency and Essential Surgical Care

Corresponding author

Correspondence to David A. Spiegel.

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Spiegel, D.A., Misra, M., Bendix, P. et al. Surgical Care and Health Systems. World J Surg 39, 2132–2139 (2015). https://doi.org/10.1007/s00268-014-2928-x

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