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Surgical care – an overlooked entity in health systems

Emi Suzuki's picture

Five billion peopletwo thirds of world populationlack access to safe and affordable surgical, anesthesia and obstetric (SAO) care while a third of the global burden of disease requires surgical and/or anesthesia decision-making or treatment. Treating the sick very often requires surgery and anesthesia. Despite such huge burden of disease, safe and affordable SAO care is often overlooked.

Why? It may be because surgery and anesthesia are not disease entities. They are treatment modalities that address the breadth of human disease — infections, non-communicable, maternal, child, geriatric and trauma-related disease and injuries, and international development agencies have been focusing on vertical disease-based programs.

Prior to 2015, global data on surgery, anesthesia and obstetric care was virtually nonexistent. With the idea that “We can’t manage what we don’t measure”, the Lancet Commission on Global Surgery developed six Surgical, Obstetric and Anesthesia (SAO) indicators (discussed here) and collected data for them. The analysis of these data show large gaps in SAO care across countries by income groups.

There are 70-times as many surgical workers per 100,000 people in high-income countries compared with low-income countries

The SAO or “surgical” workforce is extremely small in low-income countries (1 SAOs per 100,000 population) and lower middle-income countries (10 SAOs per 100,000 population) whereas there are 69 SAOs per 100,000 population in high-income countries. The discrepancy between high-income countries and low- and middle-income countries is even greater for surgical workforce density than that of physician density.

Measuring surgical systems worldwide: an update

Parisa Kamali's picture
Photo: Chhor Sokunthea / World Bank

Five billion people—two thirds of world population—lack access to safe and affordable surgical, obstetric and anesthesia care with low and middle income countries (LMICs) taking a lead.1-3 Surgical care is a crucial component of building strong health systems and one that is often overlooked (Dr. Jim Kim UHC 2017 video). All people are entitled to quality essential health services, no matter who they are, where they live, or how much money they have. This simple but powerful belief underpins the growing movement towards universal health coverage (UHC), a global commitment under the Sustainable Development Goals (SDGs). Inherent in the framework of UHC is access to safe surgical, obstetric and anesthesia (SOA) care.

An estimated 33 million undergo financial hardship every year from the direct costs of surgical care. And those are the individuals fortunate enough to have access to care.4 Moreover, about 11% of the world’s disability-adjusted life years are attributable to diseases that are often treated with surgery such as heart and cerebrovascular diseases, cancer, and injuries from road traffic accidents.2,5 Other surgically treatable disorders such as obstructed labour, obstetric fistulas, and congenital birth defects are major causes of morbidity and mortality in the developing world.5,7 The delivery of safe and quality SOA care is critical for the realization of many of the Sustainable Development Goals, including: Good health and well-being (Goal 3); No poverty (Goal 1); Gender equality (Goal 5), and Reducing inequalities (Goal 10).

One Health Approach is Critical to De-risk Human, Animal and Environmental Health

Juergen Voegele's picture
Also available: Français| Español 
Photo: Trevor Samson / World Bank

Like many, we were relieved to hear from the Government of Madagascar and WHO in November last year that the pulmonary plague outbreak in Madagascar had been contained. Plague is a disease caused by bacteria called Yersinia pestis that are typically transmitted by rodents through their fleas but can also be transmitted from human to human. Since the onset of the outbreak in early August 2017, there had been 2,300 human cases of plague reported, leading to 207 deaths (WHO update). WHO called for continued vigilance until the end of the plague season at the end of April, as more cases of bubonic plague should be expected and could lead to a resurgence of pulmonary plague. The President of Madagascar also committed to establishing a permanent “plague unit” at the level of the Prime Minister’s office to work on the eradication of plague―rightly so, as experience tells us that addressing risks at the interface of human, animal and environmental health is challenging.

Fighting for Breath: A call to action on childhood pneumonia

Kevin Watkins's picture
credit: Save The Children

Sarah Ruteri*, aged 14 months, is a survivor. A few months ago, I saw her admitted to the pediatric ward of Lodwar hospital in northern Kenya’s drought-affected Turkana district. Suffering from severe pneumonia, Sarah was gasping for breath – and fighting for her life. Her tiny ribcage was convulsed by a losing struggle to get air into her lungs. Doctors told her mother to expect the worst. But with a combination of oxygen therapy and intravenous antibiotics, Sarah pulled through.

Seeking agriculture related solutions for obesity, an increasing problem within malnutrition

Aira Htenas's picture
Also available in: Español | Français 

Rising obesity rates are in the headlines – with increasing recognition of the major role that agriculture and food systems play in the epidemic.  As agriculture economists interested in human nutrition, we wanted to take a look at what it all means, to look at how agriculture and food systems are part of the problem and how they are part of the solution. While conducting research for a recent report, a few things stood out to us.

Be the generation that ends FGM

Sandie Okoro's picture
© UNFPA
© UNFPA

Female genital mutilation/cutting (FGM/C) is an everyday reality for millions of girls and women around the world. I am no longer shocked when a woman confides in me that she has been “cut,” or tells me the consequences she lives with. Recently, I have had the privilege to meet with FGM survivors who are also activists, and they are fighting to stop the practice in a generation, reminding me that one person can make a difference in ending FGM. 

As we mark the International Day of Zero Tolerance for Female Genital Mutilation, on Feb. 6, we are supporting #EndFGM, a survivor-led movement gaining momentum and power around the world.

FGM/C, known as cutting, is a form of violence affecting at least 200 million girls and women worldwide. Every day, about 6000 women and girls suffer the practice, enduring prolonged and irreversible consequences during their entire lives

FGM/C is inextricably linked with ending extreme poverty; girls who experience it are more likely to be forced into child marriage, more likely to be poor and stay poor, and less likely to be educated. Beyond the data and the statistics, researchers have shown that FGM deprives women of sexual health and psychophysical well-being. 

Depression and its links to conflict and welfare in Nigeria

Julie Perng's picture



Chronic depression affects about 20 percent of Nigerian heads of households, according to the most recent results of the Nigerian General Household Survey (GHS) Panel, which measures indicators from agriculture, welfare, and other areas of life in Nigeria once every two to three years. This statistic is linked to an additional finding that nearly 2 out of 5 Nigerian respondents have been affected by at least one negative event, such as conflict and/or the death of a household member.

Incentives for cleaner cities in Nepal

Charis Lypiridis's picture
The "orange city" of Dhankuta, Nepal. Photo: World Bank
The "orange city" of Dhankuta, Nepal. Photo: World Bank


Cities across Nepal—and in the developing world—produce more waste than ever before, due to a spike in population and a surge in new economic activity and urbanization. Properly disposing and managing solid waste has thus become urgent for city municipalities.

Although collecting, storing, and recycling solid waste can represent up to 50 percent of a municipality’s annual budget, many local governments don’t collect enough revenue from waste management services to cover these costs.

As a result, landscapes and public spaces in Nepal’s urban centers are deteriorating. Less than half of the 700,000 tons of waste generated in Nepal’s cities each year is collected. Most waste is dumped without any regulation or oversight and several municipalities do not have a designated disposal site, leading to haphazard disposal of waste—often next to a river—further aggrevating the problem.

With urbanization rising, the costs of inaction are piling up and compromising people’s health and the environment. In most cases, the poor suffer the most from the resulting negative economic, environmental, and human health impacts.

Announcing Funding for 12 Development Data Innovation Projects

World Bank Data Team's picture

We’re pleased to announce support for 12 projects which seek to improve the way development data are produced, managed, and used. They bring together diverse teams of collaborators from around the world, and are focused on solving challenges in low and lower middle-income countries in Sub-Saharan Africa, East Asia, Latin America, and South Asia.

Following the success of the first round of funding in 2016, in August 2017 we announced a $2.5M fund to support Collaborative Data Innovations for Sustainable Development. The World Bank’s Development Data group, together with the Global Partnership for Sustainable Development Data, called for ideas to improve the production, management, and use of data in the two thematic areas of “Leave No One Behind” and the environment. To ensure funding went to projects that solved real people’s problems, and built solutions that were context-specific and relevant to its audience, applicants were required to include the user, in most cases a government or public entity, in the project team. We were also looking for projects that have the potential to generate learning and knowledge that can be shared, adapted, and reused in other settings.

From predicting the movements of internally displaced populations in Somalia to speeding up post-disaster damage assessments in Nepal; and from detecting the armyworm invasive species in Malawi to supporting older people in Kenya and India to map and advocate for the better availability of public services; the 12 selected projects summarized below show how new partnerships, new methods, and new data sources can be integrated to really “put data to work” for development.

This initiative is supported by the World Bank’s Trust Fund for Statistical Capacity Building (TFSCB) with financing from the United Kingdom’s Department for International Development (DFID), the Government of Korea and the Department of Foreign Affairs and Trade of Ireland.

2018 Innovation Fund Recipients


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