Five billion people—two thirds of world population—lack 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.
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.