Lancet Commission in Global Surgery

June 2014

Parliament of Sierra Leone

Lancet Commission in Global SurgeryHouse of Parliament

Session # 1June 2014

Resolutions• Key messages• Metrics• Recommendations• Future Research• Requirements for safe surgery

Terms of Reference• You will need your smartphone or computer• If you have neither with you – Katie will get you

some paper• Use your subject line for the title of the resolution• You may vote up or down on a resolution or

change/edit it in your vote• You may also use your own ideas• “Vote early and often”• You may NOT vote to impeach the commission

chairs

Key Messages• What is a Key Message? eg: GH2035 • Let’s get started:– Pull up a new email message– jmeara@pih.org– Type “Key Messages” in subject line– You may vote for ONLY 3 (THREE) key messages – You may make up your own messages– Or, mix and match

Key Messages (type “Key Messages” in subject line)

1. Rights/equity (Farmer resolution): 5 billion people do not have access to safe affordable surgical and anesthesia care when needed

2. Structure/process (Jim Kim resolution): Surgery is an indivisible, indispensible component of a properly functioning health system

3. Governance/management (Eva Hanciles resolution): Huge gains in surgical care provision are possible with already existing health care systems by employing proper governance and management principles and training processes

4. Economic (Yamey/Conteh/Yip resolution): Investments in surgery are pro growth, cost effective, have a positive ROI etc…

Metrics(yes or no on all)

1. Proximity: Percent of population within 2 hours to a facility capable of safe emergency surgery

2. Timeliness: Emergency surgery performed within 24 hours3. Workforce: Trained providers per population4. Throughput: Procedure rate per population5. Elective to emergency procedure ratio6. Capacity: Percent of district-level hospitals meeting requirements for safe

surgery7. Outcomes: Peri-Operative Mortality Rate (all procedures or bellwether)8. Financial Protection: Percent of population falling into poverty or incurring

catastrophic expenditure due to out-of-pocket healthcare expenditure *9. Mixed: Unmet need for surgical care10. Strategic Planning: Inclusion of surgery within national or regional health

plans

Recommendations• Your own ideas• 3 and ONLY THREE• Be as specific as possible• Direct it to a specific stakeholder if appropriate

Recommendations - Stakeholders• Govts/MOH/MOF• WHO• WBG• USAID• Foundations – Clinton/Gates• NGOs• Academic medical centers – HIC or LMICS• Colleges and professional societies – HIC or LMICS• Industry• Patients

Future Research Agenda• Choose 3 on your own• What are the 3 most important things in which to invest research

resources in the next 5-10 years?• Potential categories

– Access– Burden– Quality– Safety– Workforce– Implementation– Benchmarking– Cost of care delivery– Barriers to access/care– Patient experience

Requirements for Safe Surgeryyes or no on all

1. Staff: A trained surgical provider and team2. Staff: A trained anesthesia provider and team3. Staff: Postop nursing care, and physiological observations4. Staff: 24/7 surgical cover to review & assess patients5. Stuff: Equipment, supplies, consumables, antibiotics and pain meds6. Stuff: Equipment maintenance7. Stuff: Sterilization capability8. Stuff: Screened and cross-matched blood9. Stuff/Staff protection: Gloves, and the ability to test for HIV10. Process: Safe surgery checklist *11. Process: Preoperative risk assessment and operation planning