Essential Surgery is the first volume in the Disease Control Priorities, third edition (DCP3) series. DCP3 endeavors to inform program design and resource allocation at the global and country levels by providing a comprehensive review of the effectiveness, cost, and cost-effectiveness of priority health interventions. The volume presents data on the surgical burden of disease, disability, congenital anomalies, and trauma, along with health impact and economic analyses of procedures, platforms, and packages to improve care in settings with severe budget limitations.

Essential Surgery identifies 44 surgical procedures that meet the following criteria: they address substantial needs, are cost effective, and are feasible to implement in low- and middle-income countries. If made universally available, the provision of these 44 procedures would avert 1.5 million deaths a year and rank among the most cost effective of all health interventions. Existing health care delivery structures can be leveraged to provide affordable and quality care, with first-level hospitals capable of delivering the majority of procedures, while addressing substantial disparities in safety. Existing infrastructure can also expand access to surgery by implementing measures such as task sharing, which has been shown to be safe and effective while countries build workforce capacity.

Nearly ten years after the second iteration of Disease Control Priorities was released, increased attention to the importance of health systems in providing access to quality care is once again reshaping the global health landscape. Low- and middle-income countries are continuing to set priorities for funding and are making decisions across an increasingly complex set of policy and intervention choices with a greater appreciation for the value of program and economic evaluations. By reviewing the large burden of surgical disorders, the cost-effectiveness of surgical procedures, and the strong public demand for surgical services, Essential Surgery makes a compelling case for improving global access to surgical care.

Contents

• Disease Control Priorities • Third Edition
• Disease Control Priorities
• Foreword
• Preface
• Abbreviations
• 1. Essential Surgery: Key Messages of This Volume
  Charles N Mock, Peter Donkor, Atul Gawande, Dean T Jamison, Margaret E Kruk, and Haile T Debas.
  • Volume Summary
  • Introduction
  • Definitions
  • Key Messages
  • Conclusions
  • Acknowledgments
  • References
• The Global Burden
  • 2. Global Burden of Surgical Conditions
    Stephen N Bickler, Thomas G Weiser, Nicholas Kassebaum, Hideki Higashi, David C Chang, Jan J Barendregt, Emilia V Noormahomed, and Theo Vos.
    • Introduction
    • Role of Surgery in Global Health
    • Challenges Estimating a Global Burden of Surgical Disease
    • Burden Averted by Scaling up Basic Surgical Care
    • Burden Averted by Scaling up Selected Subspecialty Surgical Care
    • Limitations of Current Analysis
    • Where Surgical Care Fits Among Global Health Priorities
    • Future Directions
    • References
• Surgical Interventions
  • 3. Surgery and Trauma Care
    Richard A Gosselin, Anthony Charles, Manjul Joshipura, Nyengo Mkandawire, Charles N Mock, Raymond R Price, and David Spiegel.
    • Introduction
    • Global Burden of Trauma
    • Effectiveness of Trauma Care Systems
    • Trauma Care of Specific Body Regions
    • Burns
    • Orthopedics
    • Infections
    • Conclusion
    • References
  • 4. General Surgical Emergencies
    Colin McCord, Doruk Ozgediz, Jessica H Beard, and Haile T Debas.
    • Introduction
    • Types of General Surgical Emergencies
    • Disease Burden of General Surgical Emergencies
    • Effectiveness of Surgical Treatment
    • Cost of Surgical Treatment
    • Basic Systems for Surgical Emergencies
    • New Technology
    • Barriers to Effective Service Delivery
    • Future Directions
    • References
  • 5. Obstetric Surgery
    Clark T Johnson, Timothy R B Johnson, and Richard M K Adanu.
    • Global Burden of Surgically Treatable Obstetric Conditions
    • Overview of Surgical Obstetrical Procedures
    • Effectiveness and Cost-Effectiveness of Obstetric Surgery
    • Obstetric Surgical Implementation in Low- and Middle-Income Countries
    • Conclusion: Future Directions
    • References
  • 6. Obstetric Fistula
    Mary Lake Polan, Ambereen Sleemi, Mulu Muleta Bedane, Svjetlana Lozo, and Mark A Morgan.
    • Introduction
    • Burden of Disease Due to Obstetric Fistula
    • Surgical Repair as Effective Treatment
    • Cost-Effectiveness of Surgery
    • Presurgical Procedures in Obstetric Fistula Repair
    • Patient Selection and Preoperative Care
    • Surgical Repair
    • Postoperative Training and Reintegration
    • Health System Considerations
    • Future Directions
    • References
  • 7. Surgery for Family Planning, Abortion, and Postabortion Care
    Joseph B Babigumira, Michael Vlassoff, Asa Ahimbisibwe, and Andy Stergachis.
    • Introduction
    • Surgery for Family Planning
    • Surgery for Abortion and Postabortion Care
    • References
  • 8. Surgical Interventions for Congenital Anomalies
    Diana Farmer, Nicole Sitkin, Katrine Lofberg, Peter Donkor, and Doruk Ozgediz.
    • Introduction
    • Morbidity, Mortality, and Additional Adverse Consequences
    • Challenges to Providing Care for Congenital Anomalies
    • Estimating the Impact of Pediatric Surgery on the Global Burden of Disease
    • Implementation and Surveillance Priorities
    • Action Plan
    • Conclusions
    • References
  • 9. Hernia and Hydrocele
    Jessica H Beard, Michael Ohene-Yeboah, Catherine R devries, and William P Schecter.
    • Introduction
    • Groin Hernia
    • Hydrocele
    • Conclusions
    • References
  • 10. Dentistry
    Richard Niederman, Magda Feres, and Eyitope Ogunbodede.
    • Introduction
    • Epidemiology of Caries, Periodontitis, and Noma
    • Microbiology of Caries, Periodontitis, and Noma
    • Caries
    • Periodontitis
    • Noma
    • Implications for Global Health Policy
    • Conclusions
    • References
  • 11. Cataract Surgery
    N Venkatesh Prajna, Thulasiraj D Ravilla, and Sathish Srinivasan.
    • The Global Challenge of Blindness
    • Cataract Disease
    • Comparative Safety of Surgical Interventions
    • Comparative Efficacy of Surgical Interventions
    • Measuring Costs of Surgical Programs
    • Conclusions
    • References
• Surgical Platforms and Policies
  • 12. Organization of Essential Services and the Role of First-Level Hospitals
    Colin McCord, Margaret E Kruk, Charles N Mock, Meena Cherian, Johan von Schreeb, Sarah Russell, and Mike English.
    • Introduction
    • First-Level Hospitals: Potential Versus Reality
    • Health Centers As a Surgical Platform
    • Burden of Surgically Treatable Disease and the Unmet Need
    • Surgical Outcomes at First-Level Hospitals
    • Surgical Cost and Cost-Effectiveness
    • Obstacles to Low Cost and High Cost-Effectiveness
    • Financing Surgical Care
    • Strengthening First-Level Surgical Facilities
    • Future Directions for Surgical Services
    • References
  • 13. Specialized Surgical Platforms
    Mark G Shrime, Ambereen Sleemi, and Thulasiraj D Ravilla.
    • Introduction
    • Methodology
    • Charitable Surgical Delivery Platforms
    • Temporary Surgical Delivery Platforms
    • Specialty Surgical Hospitals
    • Discussion
    • Conclusions and Recommendations
    • Acknowledgments
    • References
  • 14. Prehospital and Emergency Care
    Amardeep Thind, Renee Hsia, Jackie Mabweijano, Eduardo Romero Hicks, Ahmed Zakariah, and Charles N Mock.
    • Introduction
    • Burden of Disease
    • Current Delivery Systems
    • Costs and Effectiveness
    • Future Directions
    • Conclusions: Promises and Pitfalls
    • Annexes
    • References
  • 15. Anesthesia and Perioperative Care
    Kelly McQueen, Thomas Coonan, Andrew Ottaway, Richard P Dutton, Florian R Nuevo, Zipporah Gathuya, and Iain H Wilson.
    • Introduction
    • Anesthesia and the Global Burden of Disease
    • Safe Anesthesia for Surgical Interventions
    • Cost, Effectiveness, and Cost-Effectiveness of Safe Anesthesia
    • Future Directions for Mitigating the Global Anesthesia Crisis
    • Conclusions
    • References
  • 16. Excess Surgical Mortality: Strategies for Improving Quality of Care
    Thomas G Weiser and Atul Gawande.
    • Global Volume and Safety of Surgical Care
    • Mortality Following Surgery in Lmics
    • Methodology
    • Results
    • Challenges to Surgical Services in LICs and LMICs
    • Strategies for Improving Surgical Care
    • Conclusions
    • Acknowledgments
    • Annexes
    • References
  • 17. Workforce Innovations to Expand the Capacity for Surgical Services
    Staffan Bergström, Barbara McPake, Caetano Pereira, and Delanyo Dovlo.
    • Introduction
    • Nonphysician Clinicians
    • Task-Shifting and Task-Sharing
    • Acceptance of Midlevel Providers for Major Surgery
    • Improving Working Conditions and Promoting Retention of Midlevel Providers
    • Cost-Effectiveness of Surgical Training of Midlevel Providers
    • Establishing Enabling Environments
    • Conclusions
    • References
• The Economics of Surgery
  • 18. Costs, Effectiveness, and Cost-Effectiveness of Selected Surgical Procedures and Platforms
    Shankar Prinja, Arindam Nandi, Susan Horton, Carol Levin, and Ramanan Laxminarayan.
    • Introduction
    • Why are Cost-Effectiveness data useful for Surgery?
    • Cost-Effectiveness of Surgical Interventions
    • Who Benefits from Surgical Services?
    • Surgical Intervention Costs
    • Limitations in the Evidence Base
    • Conclusions
    • Inclusion in Primary Health Care
    • Global Initiatives
    • Future Priorities
    • Annexes
    • References
  • 19. Task-Sharing or Public Finance for Expanding Surgical Access in Rural Ethiopia: An Extended Cost-Effectiveness Analysis
    Mark G Shrime, Stéphane Verguet, Kjell Arne Johansson, Dawit Desalegn, Dean T Jamison, and Margaret E Kruk.
    • Introduction
    • Methods
    • Sensitivity Analysis
    • Results
    • Discussion
    • Conclusion
    • Annex
    • References
  • 20. Global Surgery and Poverty
    William P Schecter and Sweta Adhikari.
    • Introduction
    • Disparities Between Low- and High-Income Countries
    • Inequities in Surgical Access within Countries
    • Financial Burden of Surgical Conditions
    • Conclusions
    • References
  • 21. Benefit-Cost Analysis for Selected Surgical Interventions in Low- and Middle-Income Countries
    Blake C Alkire, Jeffrey R Vincent, and John G Meara.
    • Introduction
    • Benefit-Cost Analysis and Global Health
    • Benefit-Cost Analysis of a Cleft Lip and Palate Surgical Subspecialty Hospital in India
    • Benefit-Cost Analysis of Cesarean Delivery for Obstructed Labor
    • Conclusions
    • Acknowledgments
    • References
• DCP3 Series Acknowledgments
• Series and Volume Editors
• Contributors
• Advisory Committee to the Editors
• Reviewers

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Attribution—Please cite the work as follows: Debas, H. T., P. Donkor, A. Gawande, D. T. Jamison, M. E. Kruk, and C. N. Mock, editors. 2015. Essential Surgery. Disease Control Priorities, third edition, volume 1. Washington, DC: World Bank. doi:10.1596/978-1-4648-0346-8. License: Creative Commons Attribution CC BY 3.0 IGO

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ISBN (paper): 978-1-4648-0346-8

ISBN (electronic): 978-1-4648-0367-3

DOI: 10.1596/978-1-4648-0346-8

Cover photo: The 16 Makara hospital in Cambodia’s remote Preah Vihear province is equipped with modern equipment. The maintenance of 16 Makara is supported by the World Bank and other international donors through the Health Sector Support Program and the Cambodia Second Health Sector Support Program. Photo: © Chhor Sokunthea/World Bank. Further permission required for reuse.

Cover and interior design: Debra Naylor, Naylor Design, Washington, DC

Library of Congress Cataloging-in-Publication Data

Essential surgery / volume editors, Haile T. Debas, Peter Donkor, Atul Gawande, Dean T. Jamison, Margaret E. Kruk, Charles N. Mock.

p ; cm. — (Disease control priorities ; v. 1)

Previously published in: Disease control priorities in developing countries, 2nd ed. c2006.

ISBN 978-1-4648-0346-8 (v. 1 : pb) — ISBN 978-1-4648-0097-9 (v. 1 : hc)

I. Debas, Haile T., editor. II. Disease control priorities in developing countries. III. Series: Disease control priorities ; v. 1.

[DNLM: 1. General Surgery—economics. 2. Developing Countries. WA 395]

RD27.42

362.197—dc23

2014037594