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Sonderman KA, Citron I, Mukhopadhyay S, Albutt K, Taylor K, Jumbam D, Iverson KR, Nthele M, Bekele A, Rwamasirabo E, Maongezi S, Steer ML, Riviello R, Johnson W, Meara JG. Framework for developing a national surgical, obstetric and anaesthesia plan. BJS Open 2019; 3:722-732. [PMID: 31592517 PMCID: PMC6773655 DOI: 10.1002/bjs5.50190] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 05/09/2019] [Indexed: 01/23/2023] Open
Abstract
Background Emergency and essential surgical, obstetric and anaesthesia (SOA) care are now recognized components of universal health coverage, necessary for a functional health system. To improve surgical care at a national level, strategic planning addressing the six domains of a surgical system is needed. This paper details a process for development of a national surgical, obstetric and anaesthesia plan (NSOAP) based on the experiences of frontline providers, Ministry of Health officials, WHO leaders, and consultants. Methods Development of a NSOAP involves eight key steps: Ministry support and ownership; situation analysis and baseline assessments; stakeholder engagement and priority setting; drafting and validation; monitoring and evaluation; costing; governance; and implementation. Drafting a NSOAP involves defining the current gaps in care, synthesizing and prioritizing solutions, and providing an implementation and monitoring plan with a projected cost for the six domains of a surgical system: infrastructure, service delivery, workforce, information management, finance and governance. Results To date, four countries have completed NSOAPs and 23 more have committed to development. Lessons learned from these previous NSOAP processes are described in detail. Conclusion There is global movement to address the burden of surgical disease, improving quality and access to SOA care. The development of a strategic plan to address gaps across the SOA system systematically is a critical first step to ensuring countrywide scale‐up of surgical system‐strengthening activities.
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Affiliation(s)
- K A Sonderman
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - I Citron
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - S Mukhopadhyay
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - K Albutt
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.,Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - K Taylor
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - D Jumbam
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - K R Iverson
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - M Nthele
- Zambian Ministry of Health, Lusaka, Zambia
| | - A Bekele
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - E Rwamasirabo
- King Faisal Hospital/Oshen, Rwanda Surgical Society, Kigali, Rwanda
| | - S Maongezi
- Tanzania Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | - M L Steer
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - R Riviello
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - W Johnson
- Emergency and Essential Surgical Care Programme, World Health Organization, Geneva, Switzerland
| | - J G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
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