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 | [email protected]
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