Each year, surgically treatable conditions account for approximately 30% of the global burden of disease and an estimated 5 billion people go without access to critical surgical care. Though many surgical procedures save lives, promote economic development, and are known to be cost-effective, there remains a lack of public energy and support to improve and sustain access to surgical procedures in many low- and middle-income countries (LMICs). These efforts are particularly needed in the case of pediatric surgical care, as treatment in childhood can prevent further complications in adulthood and can have a lasting impact on the social and economic wellbeing of the child across the life course.
There are a number of challenges in prioritizing access to children’s surgery around the world. First, surgeries are often viewed as an elective luxury item and are excluded from child health programs that place emphasis on other public health areas. Moreover, there are differing levels of support that vary depending on the child’s condition. For example, some conditions are seen as too expensive and complex to treat – like cardiac surgeries – while others have challenges of the stigma that may make them more difficult to appeal to a broad public audience, as in the case of treatments for hernias and colorectal malformations. These challenges are then further complicated by the lack of needed infrastructure to provide surgical care to people of all income and social strata in many LMICs.
Recently, the Lancet Commission on Global Surgery set a target of 80% coverage of essential surgical and anesthesia services by 2030 to address this global health challenge. Critical to reaching this goal is supporting the infrastructure and integration of surgical care into existing health systems and reducing barriers to accessing treatment worldwide.
So what is to be done to reach this target and ensure increased access to surgical care? The following are four areas where governments, global health organizations, NGOs, nonprofits, and all who participate in global health work might consider as they strategize ways to address surgically treatable conditions:
Cover or reduce out-of-pocket costs. For many of the world’s children, out-of-pocket costs are an insurmountable barrier to surgical care. Governments, NGOs, and other health organizations should work to reduce or eliminate costs in order to ensure that children living in the lowest income strata have access to care.
Support the growing infrastructure of medical facilities and personnel capable of conducting surgical procedures. While access to care is limited in many areas of the world, it is also the case that surgical facilities are currently being or already developed in many LMICs. For example, at Childspring we make use of these facilities and support them financially by treating the vast majority of children we serve in their countries of origin.
Reduce barriers in access to treatment. Many children living in poverty reside in rural and remote areas, without regular access to surgical care. For children to have access to medical facilities, medical professionals should consider how cross-disciplinary teams of surgeons, nurses, health workers, social workers, and community leaders can help overcome the financial and mobility barriers that create gaps between children and treatment.
Strengthen physician and medical provider networks with the expertise to treat children. Often, if the solution is not readily available in one’s community, there may be someone nearby who can help. In our experience, we have found that building a global network of 376 hospitals and medical organizations has helped reduce the distance between medical experts and children in need of surgery.
Universal access to life-changing pediatric surgeries is a critical global health challenge that requires mobilizing public support and investment, supporting the growing infrastructure of surgical facilities in LMICs, and reducing barriers to identification, access, and treatment. At Childspring, we are excited to be engaged in this work and partnering with individuals and organizations interested in joining forces to one day ensure all children have access to the critical surgical care they need.