InformationHealthSystems

Access to Medical Products, Vaccines and Technologies

Access to vaccines, medicines and other health products and technologies is unequal across the world and pose an enormous economic burden on health systems and households in LMICs10. Policies to enable this access is crucial to achieve the Sustainable Development Goals, in particular target 3.8 of achieving UHC.

The treatment of disease of any kind is highly dependent upon proper access to health products for prevention, diagnosis, treatment, palliative care and rehabilitation11. In surgery, access to anaesthetic, pain medications and consumables is fundamental. It has been observed that shortages of surgical consumables such as catheters, sutures and cannulas, contribute to the lack of access to safe surgical care12. Although supply chains can be complex, fragmented and multi-factorial, their consideration is needed to enhance health system efficiency, accessibility, and performance.

Recognising that analgesic and anaesthetic medications are a fundamental component to surgery, in 2013 the WHO published a list of specific medications that should be widely available in surgical settings.

As part of our data collection program at KidsOR, we capture information on types of anaesthesia used and the type of anaesthesia provider present for each operation. We also capture the availability of anaesthetic, pain and antibiotic medicines which allows for greater understanding within this fundamental building block in surgical systems. This information has an important use in advocating for essential medicine supply strengthening within surgical services around the world.

When it comes to new technologies, the clinical benefits of laparoscopy are welldocumented and include lower infection rates, shorter hospital stays, and decreased postoperative pain. However, implementation can be complex and requires rigorous assessment. Laparoscopic procedures are technically more challenging and can lead to varying complications. Laparoscopy requires a greater number of consumables as well as specialised equipment and necessitates advanced training for surgeons and anaesthesiologists alike. To date, KidsOR has provided laparoscopic equipment to six sites.

Dr Zaitun Bokhary is a paediatric surgeon at Muhimbili National Hospital and the president of the Women’s Medical Association of Tanzania and explained the challenges regarding laparoscopic equipment. Dr Zaitun highlighted that no specific training was available in Tanzania and the hospital had to partner with several international stakeholders since all the staff involved with laparoscopic surgery needed meticulous tutoring. Maintenance was also flagged as a significant challenge.

‘Laparoscopic surgeries at Muhimbili National Hospital have increased capacity building. I learned from doctors [coming from abroad] and now I am teaching (…) But there are some challenges and challenge number one is the training’.

Access to Medical Products, Vaccines and Technologies

Anaesthesia Drug Availability:

When looking at 25,889 records across the KidsOR database, 95% had the necessary anaesthesia equipment and/or medicines during operations. However, 5% did report some anaesthesia resources missing during operations.

95% Not Missing

5% Missing

When looking at operations that did report anaesthesia resources missing, medication was the highest reported resource missing.

41 Oxygen

47 Blood

575 IV Fluid

96 8 Medication

Financing

According to the WHO, a sustainable health financing system needs to ensure adequate funds not only to provide quality services but also to protect patients from financial catastrophe or impoverishment. Additionally, UHC states that all individuals should receive health services without suffering financial hardship.

Despite vast evidence on the critical need for surgical care and on the health and economic benefits seen from scaling-up surgical services, national governments and external funding bodies have not secured appropriate budgets to strengthen health systems. Inadequate financing is as much a barrier as poor infrastructure and insufficient surgical workforce. Earmarked funds to disease-specific interventions have been prioritised by donor countries and institutions for decades while ignoring the shift in the epidemiology of LMICs.

This shift in disease burden has been observed for the last 25 years in both low-income countries (LICs) and LMICs. While communicable diseases (CDs) such as HIV/ AIDS, malaria and tuberculosis remain, their prevalence has steadily decreased. Meanwhile, non-communicable diseases (NCDs) such as hypertension, diabetes, cancer and injuries have increased in prevalence and are seen as the fastest growing disease category worldwide. This shift is referred to as an epidemiologic transition.

Given that 86% of premature deaths from NCDs occur in LMICs13, development assistance for health (DAH) should be allocated with careful attention to these changing patterns of disease prevalence and the corresponding treatment, prevention and management strategies. However, this has not been seen in the case of NCDs, including surgical care, which is critic to address most non-communicable diseases.

2.5 billion

2 billion

1.5 billion

1 billion

500 million

Total Disease Burden by Cause, World, 1990 to 2019

Total disease burden measured by Disability-Adjusted Life Years (DALYs) per year. DALYs measure the total burden of disease - both from years of life lost due to premature death and years lived with disability. One DALY equals one lost year of health life.

Communicable, maternal, neonatal, and nutritional diseases

Non-communicable diseases (NCDs) source: Our World in Data; IHME Global Burden of Disease (2019)