Paediatric Surgery: A good investment

The WHO states that investing in surgery is cost-effective and our studies provide concrete evidence of this. Cost-effectiveness analyses were conducted at two KidsOR sites in Uganda and Nigeria. These two sites were chosen because they were distinct in their pre-installation surgical capacity and patient population.

In Uganda, the hospital had no children’s surgical capacity before installation and cases were predominantly emergent, life-saving cases, while in Nigeria the hospital had a pre-existing children’s surgical service and saw predominantly elective cases. From the KidsOR perspective which includes donated equipment and installation, the cost to save a year of healthy life was US dollars $6.40 in the Ugandan site and $77 in the Nigerian site.

From the societal perspective, which includes local healthcare and patient resource utilisation, the cost to save a year of healthy life is $37 in the Ugandan site and $152 in the Nigerian site.

These numbers are well below each country’s GDP per capita and is also substantially lower than other well-accepted healthcare interventions. Main reasons for the higher cost to save a year of healthy life at the Nigerian site are threefold: 1) two operating theatres installed in Nigeria versus one in Uganda, 2) a higher proportion of life-saving cases performed in Uganda, and 3) a lower life expectancy in Nigeria means less years of life saved per case.

Leadership/Governance

The WHO Framework on Health Systems

Strengthening defines the leadership and governance building block as ‘the role of the government in health and its relation to other actors whose activities impact on health’14 Likewise, the World Health Assembly in 2015 requested the WHO’s Director General to ‘foster multisectoral networks and partnerships, multidisciplinary policies and action plans, and support national, regional and global efforts to develop science-based approaches to prevention, screening, and implementation of emergency and essential surgical care and anaesthesia and to enhance teaching and training programmes’15.

While it is widely recognised that nongovernmental organisations can complement domestic efforts and plug persistent gaps, good coordination and alignment between global health actors’ interventions and LMICs’ needs and priorities is key to avoid fragmentation, duplication and inefficiency of health programmes16. Lasting and meaningful change occurs when health planning becomes more participatory and consultative with the inputs of a range of stakeholders.

The development of policies and frameworks is a top priority within the Leadership and Governance building block. In this sense, the National Surgical, Obstetrics and Anaesthesia Plan (NSOAP) was recommended by the Lancet Commission on Global Surgery as the policy framework for countries to evaluate and strengthen their health systems’ capacity to deliver safe Surgical, Obstetric, and Anaesthetic (SOA) care. The development of NSOAPs have also enabled ministries of health to integrate surgical planning into their broader national health policy, strategy and plans.

National surgical plans can forge a roadmap for improving surgical care through a country‐driven process whilst engaging with local champions, civil societies, and external stakeholders to ensure domestic and international funds for development and implementation since building coalitions and working with external partners are also priorities within the Leadership and Governance building block.

As a trusted partner, KidsOR participated in the discussions for the development of NSOAPs in Zimbabwe and Namibia. In Zimbabwe, our Director for Africa was involved in the prioritisation and costing discussion and the outcome was the inclusion of children’s surgery in the strategy with appropriate targets regarding infrastructure, supplies, finance and service delivery.

Zimbabwe was the fifth country in the Southern African Development Community (SADC) region and ninth in Africa to develop and launch national surgical plans. As more countries successfully launch their NSOAPs, the plans must be extensively disseminated to help guide other countries and spur conversation on challenges and possible solutions.

NSOAPs in the different African Countries

Why is developing NSOAPs important? Better coordination among governments and international partners, visibility, political will and platform for investment.

Completed NSOAP Process

Begun NSOAP Process

Committed to NSOAP Process