The Commission Process
In 2013, a group of surgeons approached editors at The Lancet to discuss the neglected role of surgery in public health. The journal responded by opening a Commission on Global Surgery to develop and assemble the best evidence on the state of surgery worldwide, to study the economics of surgical and anesthesia care delivery, and to develop strategies for improving access.
To complete this task, a diverse group of Commissioners was selected. Three co-chairs lead the Commission: Dr. John G Meara at Harvard Medical School, Mr. Andy Leather at King’s College London, and Dr. Lars Hagander at Lund University. They are joined by 22 commissioners representing professional societies, government agencies, non-governmental organizations, and academic institutions in 14 countries. They bring expertise in surgery, anesthesia, obstetrics, oncology, health care policy, financing, economics, and research. They form the Commission’s four working groups, focusing on health care delivery and management; workforce, training, and education; information management; and finance and economics.
The Commission held its first meeting in January 2014 in Boston, USA. This meeting allowed Commissioners to conduct a consultation with 100 participants from 18 countries, to determine the scope and focus of the Commission Report, and to develop a research strategy for each working group. Over the next five months, preliminary research and ongoing public consultation continued through in-person interviews and online surveys.
Edna Adan addresses participants at the first Commission meeting, January 2014
In June, 2014 the Commission’s second meeting was held in Freetown, Sierra Leone. Participants attended from 28 countries. During this meeting, Commissioners discussed research progress and developed the Commission’s key messages. With support from independent research groups around the world, the Commission developed a report that was submitted for external peer review in September 2014. Commissioners convened again in November in Dubai, UAE to discuss and respond to peer-review comments.
Countries represented by participants of the second Commission meeting, June 2014
In addition, throughout 2014, eight regional meetings were held to assess specific regional needs and build global consensus. These included meetings in Cartagena, Colombia; São Paulo, Brazil; Chhattisgarh, India, and Singapore.
Finally, in February 2015, the Lancet Commission on Global Surgery convened a summit in Bellagio, Italy sponsored by the Rockefeller Foundation. This meeting brought together experts in global health, surgery, and industry. Bellagio commissioners discussed key aspects of implementation, strategies for sustained engagement, and opportunities for building global support for surgery as an essential component of health systems.
On April 27, 2015, the Commission Report was launched in London, UK at the Royal Society of Medicine. The report itself, titled Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development, contained five key messages for health policy makers:
Key Message 1: 5 billion people lack access to safe, affordable surgical and anaesthesia care when needed
Looking at four dimensions of access – timeliness, surgical capacity, safety, and affordability – the Commission found that 5 billion people are unable to reach surgical services.
Key Message 3: 33 million individuals face catastrophic health expenditure due to payment for surgery and anaesthesia each year
For those fortunate enough to receive surgery when they need it, access often comes at an expense that is financially catastrophic for families.
Dr. Jim Yong Kim discusses the health and economic consequences of inequities in access to surgical care, May 2015
Key Message 2: 143 million additional surgical procedures are needed each year to save lives and prevent disability
Based on surgical volume thresholds that correlate with positive health outcomes, the Commission estimated that performance of a minimum of 143 million additional surgical procedures is necessary each year to save lives and prevent disability. This need is greatest in the poorest regions of the world, including Western, Eastern, and Central sub-Saharan Africa, and South and Southeast Asia
Proportion of the population lacking access to safe, affordable surgical and anaesthesia care when needed, by country
Key Message 4: Investment in surgical and anaesthesia services is affordable, saves lives, and promotes economic growth
Low- and middle-income countries may forfeit 2% of annual GDP growth by 2030 by failing to address surgical disease as a critical component of health systems
Annual value of lost economic output due to surgical conditions. Data are percentage loss of Gross Domestic Product (GDP) by World Bank income class.
Key Message 5: Surgery is an indivisible, indispensable part of health care
Since surgery is critical to health, welfare, and economic development, governments can use the opportunities afforded by the Sustainable Development Goals to create robust National Surgical Plans and build strong, resilient surgical systems. Forward-thinking funding agencies need to consider surgery as a fundamental part of primary care.
The report was published alongside over 100 supporting papers in 7 academic journals, including a special Global Surgery edition of The Lancet Global Health with 11 papers, 57 Lancet Global Surgery Abstracts, and six Global Surgery Teaching Cases created by five different schools of business and public health.
Over 110 news agencies covered the initial report publication, including the BBC, Reuters, and the New York Times. A second launch event was held in Boston, USA, which sought to delineate a course of action for high-income country actors responding to the gross disparities in access highlighted by the Commission Report.
Videos of both initial launch events can be found on the Commission’s YouTube channel.
Toward universal access to safe, affordable surgical and anaesthesia care when needed
Preliminary work toward implementing the Commission’s findings is underway in Cabo Verde, Zambia, Madagascar, and India, with additional work being completed independently in many countries.Since its inception, the Commission has depended on engagement from a strong global network of partners including ministries of health, global health and development organizations, funders, surgical colleges, and patients and providers. Sustaining and growing these partnerships is essential to achieve the Commission's vision of universal access to safe, affordable surgical and anaesthesia care when needed.
Future Commission launch events are planned for Dubai, UAE (Oct 25, 2015); Melbourne, Australia (October 26, 2015), and Karad, India (November 19, 2015). These events will focus on the regional relevance of the Commission’s findings and recommendations.
If you represent a surgical organization or a government agency looking to complete a national assessment of surgical systems or develop a National Surgical Plan, please contact us.