WHO response

Delivering safe and affordable surgery

Key facts

Fact sheet: September 2020

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Universal access to essential surgical services could avert 1.5 million deaths annually, or 7% of avertable deaths in low- and middle-income countries.

In the Western Pacific Region, less than 80% of the population has access to common procedures (caesarean section,

laporatomy and management of open fractures) in 7 of 12 countries with data available.

Opportunities to build surgical “ecosystems” have often been missed. In some countries, one in 100 patients die after surgery.

Over 6.8 million operations were cancelled or postponed during the COVID-19

pandemic in 13 countries with data available.

Safe and affordable surgery is essential to achieving universal health coverage. Many common diseases and conditions require surgical care. Surgery not only saves lives, but also significantly improves the quality of life for millions of people.

Too often, however, surgical care has been given insufficient attention despite its importance in improving health and achieving UHC. This can lead to limited local ownership and inadequate strengthening of health systems. Unsustainable approaches fail to build local capacity, enhance service delivery or improve health outcomes.

Improving and sustaining availability and quality of surgical services requires developing

“ecosystems” that include inputs such as a trained workforce, medicines, equipment, infrastructure and data management. Supports such as sterilization, maintenance, waste disposal, laundry and utilities are also essential.

The development of surgical ecosystems requires moving away from siloed approaches that address single elements, towards broader systems processes that improve sustainability and reach. Such systems include quality and safety mechanisms in care settings, facility accreditation and licensing of surgical providers. Some areas, such as strengthening pathology and laboratory services, early diagnosis and clinical decision-making, may need special attention. To better reach high-risk communities, innovations such as mobile care, telemedicine and screening programmes may be required.

To ensure equitable access, it is essential that surgical services are affordable. Countries in the Region have different financing policies for surgical services, with varied prices, population coverage, entitlements and copayments. These financial schemes determine the level of direct (out-of-pocket) payments. The cost of surgical services, compounded by various socioeconomic and demographic factors, can lead to financial hardship for certain population groups.

For sustainable, universal access to safe and affordable surgery, new approaches to solving health systems challenges are required. Improving surgical care must be part of a robust health system.

WHO has developed the Action Framework for Safe and Affordable Surgery in the Western Pacific Region (2021-2030). The Framework guides Member States through a process of identifying actions to strengthen or redesign surgical ecosystems, that can be incorporated into health plans.

The process involves (1) engaging stakeholders within and beyond the health sector to create a shared national vision for safe and affordable surgery, (2) working backwards from the vision to determine how current systems can be strengthened and re-designed, (3) identifying actions to include in short, medium and long-term national health and development plans, and carrying out monitoring and evaluation for recalibrating plans.

The COVID-19 pandemic provides an impetus to improve the capacity, resilience and responsiveness of health systems for surgery, which will in turn support improved access, availability and quality of a range of essential services. Investments in surgical care have long-lasting impacts on infection prevention and control practices, hygiene resources and critical care. For this reason, improving surgical care services can strengthen systems overall, with multiple benefits.

WHO response

WPR/2020/RDO/005

©World Health Organization 2020

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