Commission Overview

Andrew JM Leather MBBS, MS, FRCSDirector, King’s Centre for Global Health

King’s Health Partners and King’s College LondonTrauma and General Surgeon

King’s College Hospital, London

1www.gscommission.com | @GSCommission | facebook.com/GSCommission

Over next 15 minutes

• Talking Points– vision– process thus far– goals– future plans

• End Goals– common knowledge regarding commission’s

purpose and position

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Role of surgical care in the health of populations

Lifecourse Approach

• Perinatal & infancy• e.g. birth asphyxia,

gastrochisis• Childhood

• e.g. hernia, burns, abscesses

• Adolescence• e.g. trauma

• Pregnancy & childbirth• e.g. obstructed labour,

hemorrhage, eclampsia• Women's health

• e.g. reproductive tract neoplasms, genital prolapse, safe abortions

• Men's health• e.g. prostatic hypertrophy,

hypospadias• Older people's health

• e.g. cataract surgery

Disease Burden Approach

• Trauma/injury/violence• e.g. fractures, burns

• Obstetric complications• e.g. PPH, obstetric fistula

• Congenital disease• e.g. cleft lip and palate,

club foot, ARM• Neoplastic disease

• e.g. breast, gastric, colorectal ca

• Infection & sepsis• e.g. gangrene, abscess,

AMC• General surgical

conditions• e.g. appendicitis, renal

calculi, hernia, cholecystitis• Infectious disease

sequelae• e.g.bladder ca

(schistosomiasis), rheumatic valvular disease

• Reproductive health• e.g. AMC, malignancy

• Vision & hearing• e.g. cataracts

Level of Care Approach

• Prevention• e.g. AMC for HIV,

orchidopexy for undescended testes

• Screening• e.g. Post-natal screening

for congenital anomalies (hip dysplasia, clubfoot)

• Diagnosis• e.g. Tumor biopsy,

diagnostic laparoscopy• Treatment (1°)

• e.g. incarcerated hernia • Treatment (2°)

• e.g. contracture release (leprosy, burns)

• Palliative• e.g. stent for obstructed

viscous

Myths

• Little disease• Too expensive• Too complex• Not a priority• Too many initiatives• HIC surgical community will fix it

LANCET COMMISSIONS

• Inform and drive policy change• Generate broad sustainable improvement

in critical areas of global health

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Aligns with DCP3 publication

• 9 volumes• Volume 1: Essential Surgery• 44 essential surgical conditions and the

procedures/other care required to treat them• Chosen by consensus• 28/44 delivered at 1st level hospitals• 23/28 emergency procedures• Universal coverage of essential surgery

WHA Resolution

Global Surgery

Improved health and health equity for all

Underserved populations Populations in crisis

LMICs HICs Conflict and Displacement

Disaster

VISION

Universal access to safe, high quality surgical and anesthesia care when needed with financial protection

Over next 15 minutes

• Talking Points– vision– process thus far– goals– future plans

• End Goals– common knowledge regarding commission’s

purpose and position

11

www.globalsurgery.info

twitter.com/gscommission

facebook.com/gscommission

Lancet Commission on Global Surgery

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Healthcare Delivery & Management

Workforce Training & Education

Information Management

Finance & Economics

Key MessagesRecommendations

Metrics

Over next 15 minutes

• Talking Points– vision– process thus far– goals– future plans

• End Goals– common knowledge regarding commission’s

purpose and position

16

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Commission Outputs

Research

ReportTeaching Cases

Advocacy

Surgery

Health System Strengthening

Universal Health Coverage

ROLE

Surgery

• Not surgery instead of anything else

ROLE

• Not surgery instead of anything else• Surgery WITH everything else

Surgery

ROLE

• Not surgery instead of anything else• Surgery WITH everything else• Surgery alone isn’t the answer to

NCDs, maternal child health, etc…

Surgery

ROLE

• Not surgery instead of anything else• Surgery WITH everything else• Surgery alone isn’t the answer to

NCDs, cancer, maternal child health, etc…

• Surgery as a partner in health care delivery adds value to all of the above

Surgery

ROLE

GOALS

Assessment

• Current status• What is working and what isn’t• Barriers and Problems• Solutions• Within different contexts

GOALS

Recommendations • All stakeholders• Role for each

Assessment

GOALS

Metrics

• How will we know things are improving?

• The Commission is not just a report• Decade long process, broad

engagement

Assessment Recommendations

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Commission Outputs

Research

ReportTeaching Cases

Advocacy

Establishing an Alliance for Global Surgery & Anaesthesia Advocacy

Tuesday, October 28, 2014 | 1:00 - 2:30 pm | Marriott Marquis San Francisco Hosted by the G4 Alliance | Contact@theg4alliance.org

INFO SESSION

Goal: ensure that surgery is on the Global Reference List of Core Health Indicators

Over next 15 minutes

• Talking Points– vision– process thus far– goals– future plans

• End Goals– common knowledge regarding commission’s

purpose and position

29

Past, present and future

• Involvement of all stakeholders• The process will be the outcome• We can write the most perfectly

written, eloquent report, however…• …if all stakeholders, leaders,

clinicians and patients don’t consider this THEIR commission – we will not change a thing!

Launch Events – starting in London and Boston

• Commission launch 27th April 2015 at the Royal Society of Medicine, London, UK

https://www.rsm.ac.uk/events/events-listing/2014-2015/groups/global-health/ghf25-lancet-global-surgery-commission-launch.aspx• UK/high income country response to the Commission on 28th

April 2015 at the Royal Society of Medicine, London, UKhttps://www.rsm.ac.uk/events/events-listing/2014-2015/groups/global-health/ghf10-global-surgery,-anaesthesia,-and-obstetrics-shifting-paradigms-and-challenging-generations.aspx

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Political priority

• The degree to which international and national political leaders actively give attention to an issue, and back this up with the provision of financial, technical and human resources that are commensurate with the severity of the issue.

J Shiffman, Lancet. 2007;370:1370-79

Understanding political priority in global health

Shiffman, J & Smith, S. Lancet. 2007;370:1370-9

Future plans: help define, launch and support a global surgery movement

Lancet Commission team: 2 decades of measurement ahead!

Thank you

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Key Message #1

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x billion people lack

access

How many lack access and why?

Key Message #2

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x million surgical

procedures needed

How many procedures

are needed?

Key Message #3

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x million experience

catastrophic expense

How many can not afford

surgery?

Key Message #4

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Investment in surgery saves lives

and promotes economic growth

Can we save lives and grow the

economy?

Key Message #5

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Surgery essential for global health

goals

Is surgery integral to

health systems?

Recommendations

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Investment• Substantial national and

international• Increase capacity• Improve access• Quality and safety

Workforce• LICs – dramatic scale up• MICs – areas of unmet

need and/or district level

Universal Health Coverage• Must include surgical and

anesthesia care• Financial protection• Strategic purchasing

Metrics• Investment in quality data

collection and reporting• Credible indicators to

track progress• Tracking financing flows

National Surgical Plan• MOH• Stakeholders• Transparent, time bound

metrics

Research• Local capacity• Local priorities• Increased funding

LCoGS Metrics/Indicators

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Access to emergency

surgery

Safe surgery infrastructure

SAO provider density

Surgical volume

Postoperative mortality rate

Financial protection

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Commission Outputs

Research

ReportTeaching Cases

Advocacy