Friday, November 8, 2013
West End Ballroom A (Washington Marriott)
*Names in bold indicate Presenter
Despite the recognition that surgical conditions account for a significant percentage of the world’s burden of disease and that there are gross deficiencies in access to surgical care especially for the more marginalized segments of the population in low and middle-income countries (LMICs), the provision of surgical care has historically been a low priority on the global health agenda. Appealing to social constructivist thought, the purpose of this paper is to examine the factors that have both enhanced and hindered the ability of what we will refer to as “essential surgery” (ES) to gain political priority. Recognizing four categories of factors that shape political priority, the Shiffman-Smith framework is used to assess essential surgical care’s (as an emerging global health topic of concern): 1) actor power, 2) internal and external framing of the issue, 3) context within which the actors are operating, and 4) characteristics of the issue itself. The paper draws on secondary data from published scholarly literature, conference meeting notes, and reports from various organizations and networks, as well as semi-structured interviews with key informants, who are representatives from Ministries of Health in developing countries and those that are engaged in global surgical networks. While ES has the potential to gain political priority in the future, there are several crucial factors that currently obstruct its advancement on the global health agenda. First, there is no policy community cohesion, unifying political entrepreneur, or mobilization of civil society to champion the cause. An epistemic community, the actors involved in promoting essential surgery globally are largely fragmented and are primarily composed of a small sub-set of surgeons and anesthesiologists that are concerned with the state of surgical care in LMICs, but whom have yet to collectively define their objectives and propose specific courses of action under a formal initiative. Second, there is a lack of consensus in defining “surgery”, and what constitutes “essential” surgery, as it largely depends upon contextual variables including local disease burden and the level of service delivery within the health system. Third, insufficient effort was made to take advantage of the Millennium Development Goals as a policy window and efforts to capitalize on policies geared towards general “health systems strengthening” is lacking. Finally, there is limited data and a lack of accepted metrics available to capture the burden of surgical diseases, which is needed to quantify the magnitude of the problem and ultimately present it as a critical, unmet need.