Increasing Access to Surgical Services in Sub-Saharan Africa: Priorities for National and International Agencies Recommended by the Bellagio Essential Surgery Group

BackgroundIn sub-Saharan Africa, there is a growing awareness of the burden of paediatric surgical diseases. This has highlighted the large discrepancy between the capacity to treat and the ability to afford treatment, and the effect of this problem on access to care. This review focuses on the sources and challenges of funding paediatric surgical procedures in sub-Saharan Africa. MethodsWe undertook a search for studies published between January 2007 and November 2016 that reported the specific funding of paediatric surgical procedures and were conducted in sub-Saharan Africa. Abstract screening, full-text review and data abstraction were completed and resulting data were analysed using Statistical Package for Social Sciences (SPSS) software. ResultsThirty-five studies met our inclusion criteria and were reviewed. The countries that were predominantly emphasized in the publications reviewed were Nigeria, South Africa, Kenya, Ghana and Uganda. The paediatric surgical procedures involved general paediatric surgery/urology, cardiac surgery, neurosurgery, oncology, plastics, ophthalmology, orthopaedics and otorhinolaryngology. The mean cost of these procedures ranged from 60 to 21,140 United States Dollars (USD). The source of funding for these procedures was mostly out-of-pocket payments (OOPs) by the patient’s family in 32 studies, (91.4%) and medical mission/non-governmental organizations (NGOs) in 21 (60%) studies. This pattern did not differ appreciably between the articles published in the initial and latter 5 years of the study period, although there was a trend towards a reduction in OOP funding. Improvements in healthcare funding by individual countries supported by international organizations and charities were the predominant suggested solutions to challenges in funding.ConclusionWhile considering the potential limitations created by diversity in study design, the reviewed publications indicate that funding for paediatric surgical procedures in sub-Saharan Africa is mostly by OOPs made by families of the patients. This may result in limited access to some procedures. Coordinated efforts, and collaboration between individual countries and international agencies, may help to reduce OOP funding and thus improve access to critical procedures.

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The Historiography of HIV and AIDS in Uganda

History in Africa ◽

10.1353/hia.0.0009 ◽

2008 ◽

Vol 35 ◽

pp. 301-325 ◽

Cited By ~ 6

Author(s):

Jan Kuhanen

Keyword(s):

News Media ◽

Behavioral Interventions ◽

Scientific Information ◽

International Health ◽

Hiv And Aids ◽

Sub Saharan Africa ◽

International Agencies ◽

The World ◽

Sub Saharan ◽

Donor Agencies

Uganda has been in the world headlines since the mid-1980s, first as a nation severely hit by HIV and AIDS, and later, from the late 1990s onwards, as the first country in sub-Saharan Africa that has managed to reverse a generalised HIV epidemic. Countless newspaper articles, television and radio documentaries and broadcasts, papers, books, and films have been produced about AIDS in Uganda, making the epidemic one of the most thoroughly researched and documented in the world. Medical doctors, virologists, epidemiologists and social and behavioral scientists, both Ugandan and expatriate, have produced massive amounts of scientific information about it since the early 1980s, in addition to which there have been policy papers, evaluation reports, and action plans produced by various government ministries, international donor agencies, and national and international NGOs and relief organizations which document the epidemic from administrative, developmental, and humanitarian perspectives.Uganda's AIDS epidemic has been publicized worldwide through the news media and various international agencies. It is being constantly monitored not only by national authorities and international health experts, but by myriads of Ugandan and international organizations, media, academics, and concerned members of the public using modern means of communication. Some of these national and international bodies not only monitor, report and educate, but demand their say in how the epidemic should be managed. Uganda has become a testing ground for medical and behavioral interventions, as exemplified by AIDS vaccination trials, the social marketing of condoms, antiretroviral treatment, and, recently, by the male circumcision trial. Positive results have then been marketed to other countries in sub-Saharan Africa as successful AIDS prevention strategies.

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Sustainable Development Goals (SDGs): Far from Achievement for Sub-Saharan Africa

10.20944/preprints202005.0447.v1 ◽

2020 ◽

Author(s):

HADSON SITEMBO

Keyword(s):

South Africa ◽

Sustainable Development ◽

Sustainable Development Goals ◽

Secondary Data ◽

Sub Saharan Africa ◽

African Countries ◽

International Agencies ◽

Depth Analysis ◽

Development Goals ◽

Sub Saharan

Sustainable development goals (SDGs) are a global agenda consisting of 17 goals which are to be achieved in 2030 by all member states. SDGs are more holistic goals i.e. these goals are closely interrelated and they affect the progress of one another. Sub-Saharan Africa countries are, once more lagging behind in the implementations of SDGs despite the efforts by governments, non-government organisations and international agencies. Rwanda, South Africa and Zambia where the three Sub-Saharan Africa countries on which the study focused. The three countries in this study were chosen on the basis that they cater to the general overview of African countries performance on SDGs. To conduct this study, a desk research method was adopted and secondary data was utilised. An in-depth analysis was done on the on three subs Saharan African countries i.e. Rwanda, South Africa, Zambia. Those goals where serious attention is needed are goals 1-9, 16 and 17. Most Sub-Saharan African countries performed better on goals 11, 12 and 15. It was concluded that the achievement of Sustainable development goals remains a mere dream for Sub Saharan Africa unless serious interventions are made.

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Role of UK Hospitals in Supporting Surgical Training in Africa

Bulletin of The Royal College of Surgeons of England ◽

10.1308/147363510x533676 ◽

2010 ◽

Vol 92 (10) ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Caris Grimes ◽

Christopher Lavy

Keyword(s):

Surgical Training ◽

Urban Areas ◽

Developed Countries ◽

Sub Saharan Africa ◽

Surgical Safety ◽

Surgical Services ◽

Aids Epidemic ◽

District Hospitals ◽

Sub Saharan ◽

And Migration

There are significant problems surrounding lack of access to surgical services, surgical training and surgical safety in Africa. There are many reasons for this. A recent report suggests that the ongoing healthcare workforce crisis is set to get worse in sub-Saharan Africa, with an estimated shortfall of 800,000 health professionals by 2015 and a required additional wage bill of approximately US $2.6 billion. Reasons include a lack of medical school places to meet demand; poor wages, facilities and infrastructure; impact of the HIV/AIDS epidemic; and migration to urban areas and developed countries. For example, although Kenya has trained 300 surgeons since 1972 only 120 of them remain in public service, with 27 of its 63 district hospitals having no qualified surgeons.

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Two Birds, One Stone—Reframing Cooking Energy Policies in Africa and Asia

Energies ◽

10.3390/en12091591 ◽

2019 ◽

Vol 12 (9) ◽

pp. 1591 ◽

Cited By ~ 8

Author(s):

Simon Batchelor ◽

Ed Brown ◽

Nigel Scott ◽

Jon Leary

Keyword(s):

Global South ◽

Combustion Efficiency ◽

Sub Saharan Africa ◽

International Agencies ◽

New Strategy ◽

Cooking Energy ◽

Alternative Approaches ◽

Sub Saharan ◽

Business As Usual ◽

Global Transition

For the past 40 years, the dominant ‘policy’ on cooking energy in the Global South has been to improve the combustion efficiency of biomass fuels. This was said to alleviate the burdens of biomass cooking for three billion people by mitigating emissions, reducing deforestation, alleviating expenditure and collection times on fuels and increasing health outcomes. By 2015, international agencies were openly saying it was a failing policy. The dispersal of improved cookstoves was not keeping up with population growth, increasing urbanisation was leading to denser emissions and evidence suggested health effects of improved stoves were not as expected. A call was made for a new strategy, something other than ‘business as usual’. Conventional wisdom suggests that access to electricity is poor in Sub-Saharan Africa (SSA), that it is too expensive and that weak grids prevent even connected households from cooking. Could a new strategy be built around access to electricity (and gas)? Could bringing modern energy for cooking to the forefront kill two birds with one stone? In 2019, UK Aid announced a multi-million-pound programme on ‘Modern Energy Cooking Services’ (MECS), specifically designed to explore alternative approaches to address cooking energy concerns in the Global South. This paper outlines the rationale behind such a move, and how it will work with existing economies and policies to catalyse a global transition.

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Addressing quality in surgical services in sub-Saharan Africa: hospital context and data standardisation matter

BMJ Quality & Safety ◽

10.1136/bmjqs-2021-013259 ◽

2021 ◽

pp. bmjqs-2021-013259

Author(s):

Tihitena Negussie Mammo ◽

Thomas G Weiser

Keyword(s):

Sub Saharan Africa ◽

Surgical Services ◽

Sub Saharan

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Geospatial mapping of access to timely essential surgery in sub-Saharan Africa

BMJ Global Health ◽

10.1136/bmjgh-2018-000875 ◽

2018 ◽

Vol 3 (4) ◽

pp. e000875 ◽

Cited By ~ 25

Author(s):

Sabrina Juran ◽

P. Niclas Broer ◽

Stefanie J. Klug ◽

Rachel C. Snow ◽

Emelda A. Okiro ◽

...

Keyword(s):

Travel Time ◽

Sub Saharan Africa ◽

Ancillary Data ◽

Surgical Disease ◽

Country Level ◽

Time Estimates ◽

Essential Surgery ◽

Scale Population ◽

Estimate Travel Time ◽

Sub Saharan

IntroductionDespite an estimated one-third of the global burden of disease being surgical, only limited estimates of accessibility to surgical treatment in sub-Saharan Africa exist and these remain spatially undefined. Geographical metrics of access to major hospitals were estimated based on travel time. Estimates were then used to assess need for surgery at country level.MethodsMajor district and regional hospitals were assumed to have capability to perform bellwether procedures. Geographical locations of hospitals in relation to the population in the 47 sub-Saharan countries were combined with spatial ancillary data on roads, elevation, land use or land cover to estimate travel-time metrics of 30 min, 1 hour and 2 hours. Hospital catchment was defined as population residing in areas less than 2 hours of travel time to the next major hospital. Travel-time metrics were combined with fine-scale population maps to define burden of surgery at hospital catchment level.ResultsOverall, the majority of the population (92.5%) in sub-Saharan Africa reside in areas within 2 hours of a major hospital catchment defined based on spatially defined travel times. The burden of surgery in all-age population was 257.8 million to 294.7 million people and was highest in high-population density countries and lowest in sparsely populated or smaller countries. The estimated burden in children <15 years was 115.3 million to 131.8 million and had similar spatial distribution to the all-age pattern.ConclusionThe study provides an assessment of accessibility and burden of surgical disease in sub-Saharan Africa. Yet given the optimistic assumption of adequare surgical capability of major hospitals, the true burden of surgical disease is expected to be much greater. In-depth health facility assessments are needed to define infrastructure, personnel and medicine supply for delivering timely and safe affordable surgery to further inform the analysis.

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RTS,S/AS01, a vaccine targeting pre-erythrocytic stages of Plasmodium falciparum

Emerging Topics in Life Sciences ◽

10.1042/etls20170101 ◽

2017 ◽

Vol 1 (6) ◽

pp. 533-537

Author(s):

Lorenz von Seidlein ◽

Borimas Hanboonkunupakarn ◽

Podjanee Jittmala ◽

Sasithon Pukrittayakamee

Keyword(s):

Protective Efficacy ◽

Age Groups ◽

Sub Saharan Africa ◽

Phase Iii ◽

European Medicines Agency ◽

Older Children ◽

Pivotal Phase ◽

Malaria Epidemiology ◽

Maximum Benefit ◽

Sub Saharan

RTS,S/AS01 is the most advanced vaccine to prevent malaria. It is safe and moderately effective. A large pivotal phase III trial in over 15 000 young children in sub-Saharan Africa completed in 2014 showed that the vaccine could protect around one-third of children (aged 5–17 months) and one-fourth of infants (aged 6–12 weeks) from uncomplicated falciparum malaria. The European Medicines Agency approved licensing and programmatic roll-out of the RTSS vaccine in malaria endemic countries in sub-Saharan Africa. WHO is planning further studies in a large Malaria Vaccine Implementation Programme, in more than 400 000 young African children. With the changing malaria epidemiology in Africa resulting in older children at risk, alternative modes of employment are under evaluation, for example the use of RTS,S/AS01 in older children as part of seasonal malaria prophylaxis. Another strategy is combining mass drug administrations with mass vaccine campaigns for all age groups in regional malaria elimination campaigns. A phase II trial is ongoing to evaluate the safety and immunogenicity of the RTSS in combination with antimalarial drugs in Thailand. Such novel approaches aim to extract the maximum benefit from the well-documented, short-lasting protective efficacy of RTS,S/AS01.

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Mortality and Society in Sub-Saharan Africa

Population Studies ◽

10.1080/0032472031000147416 ◽

1993 ◽

Vol 47 (3) ◽

pp. 555-556

Author(s):

Lado Ruzicka

Keyword(s):

Sub Saharan Africa ◽

Sub Saharan

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