Surgical leadership in Africa – challenges and opportunities

AbstractSurgical care has been described as one of the Cinderellas in the global health development agenda, taking a backseat to public health, child health, and infectious diseases. In the midst of such competing health-care needs, surgical care, often viewed by policy makers as luxurious and the preserve of the rich, gets relegated to the bottom of priority lists. In the meantime, infectious disease, malnutrition, and other ailments, viewed as largely affecting the poor and disadvantaged in society, get embedded in national health plans, receiving substantial funding and public health program development. It is often stated that the main reason for this sad state of affairs in surgical care is the lack of political will to improve matters in the health sector. Indeed, in 2001, the Commission on Macroeconomics and Health concluded that the lack of political will to sufficiently increase spending on health at the sub-national, national, and international levels was perhaps the most critical barrier to improving health in low-income countries. However, at the root of this lack of political will is a lack of political priority for surgical care.

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Education in ear and hearing care in remote or resource-constrained environments

The Journal of Laryngology & Otology ◽

10.1017/s002221511800110x ◽

2018 ◽

Vol 133 (1) ◽

pp. 3-10 ◽

Cited By ~ 3

Author(s):

M P A Clark ◽

B D Westerberg ◽

D Nakku ◽

P Carling

Keyword(s):

Low Income ◽

Surgical Care ◽

Low Income Countries ◽

Resource Poor Setting ◽

Training Methods ◽

Open Approach ◽

Care Needs ◽

Ear Surgery ◽

Training Requirements ◽

Primary Means

AbstractBackgroundAt the heart of surgical care needs to be the education and training of staff, particularly in the low-income and/or resource-poor setting. This is the primary means by which self-sufficiency and sustainability will ultimately be achieved. As such, training and education should be integrated into any surgical programme that is undertaken. Numerous resources are available to help provide such a goal, and an open approach to novel, inexpensive training methods is likely to be helpful in this type of setting.The need for appropriately trained audiologists in low-income countries is well recognised and clearly goes beyond providing support for ear surgery. However, where ear surgery is being undertaken, it is vital to have audiology services established in order to correctly assess patients requiring surgery, and to be able to assess and manage outcomes of surgery. The training requirements of the two specialties are therefore intimately linked.ObjectiveThis article highlights various methods, resources and considerations, for both otolaryngology and audiology training, which should prove a useful resource to those undertaking and organising such education, and to those staff members receiving it.

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Surgical Care Needs of Low-Income Countries: A Global Estimate

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2016.08.317 ◽

2016 ◽

Vol 223 (4) ◽

pp. e127

Author(s):

Shailvi Gupta

Keyword(s):

Low Income ◽

Surgical Care ◽

Low Income Countries ◽

Care Needs ◽

Global Estimate

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COVID-19 pandemic: the implications of the natural history, challenges of diagnosis and management for care in sub-Saharan Africa

Beni-Suef University Journal of Basic and Applied Sciences ◽

10.1186/s43088-021-00106-x ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Lawrence Omo-Aghoja ◽

Emuesiri Goodies Moke ◽

Kenneth Kelechi Anachuna ◽

Adrian Itivere Omogbiya ◽

Emuesiri Kohworho Umukoro ◽

...

Keyword(s):

Public Health ◽

Natural History ◽

Low Income ◽

Sub Saharan Africa ◽

Low Income Countries ◽

Diagnosis And Management ◽

Severe Acute Respiratory Infection ◽

Identification Technique ◽

Sub Saharan ◽

Policies And Programs

Abstract Background Coronavirus disease (COVID-19) is a severe acute respiratory infection which has afflicted virtually almost all nations of the earth. It is highly transmissible and represents one of the most serious pandemics in recent times, with the capacity to overwhelm any healthcare system and cause morbidity and fatality. Main content The diagnosis of this disease is daunting and challenging as it is dependent on emerging clinical symptomatology that continues to increase and change very rapidly. The definitive test is the very expensive and scarce polymerase chain reaction (PCR) viral identification technique. The management has remained largely supportive and empirical, as there are no officially approved therapeutic agents, vaccines or antiviral medications for the management of the disease. Severe cases often require intensive care facilities and personnel. Yet there is paucity of facilities including the personnel required for diagnosis and treatment of COVID-19 in sub-Saharan Africa (SSA). It is against this backdrop that a review of key published reports on the pandemic in SSA and globally is made, as understanding the natural history of a disease and the documented responses to diagnosis and management is usually a key public health strategy for designing and improving as appropriate, relevant interventions. Lead findings were that responses by most nations of SSA were adhoc, paucity of public health awareness strategies and absence of legislations that would help enforce preventive measures, as well as limited facilities (including personal protective equipment) and institutional capacities to deliver needed interventions. Conclusion COVID-19 is real and has overwhelmed global health care system especially low-income countries of the sub-Sahara such as Nigeria. Suggestions for improvement of healthcare policies and programs to contain the current pandemic and to respond more optimally in case of future pandemics are made herein.

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Immigration and economic mobility

Journal of Population Economics ◽

10.1007/s00148-021-00851-4 ◽

2021 ◽

Author(s):

Maria F. Hoen ◽

Simen Markussen ◽

Knut Røed

Keyword(s):

Labor Market ◽

Low Income ◽

Labor Market Outcomes ◽

Lower Class ◽

Low Income Countries ◽

Market Outcomes ◽

Wide Range ◽

Class Background ◽

The Rich ◽

Relative Prime

AbstractWe examine how immigration affects natives’ relative prime-age labor market outcomes by economic class background, with class background established on the basis of parents’ earnings rank. Exploiting alternative sources of variation in immigration patterns across time and space, we find that immigration from low-income countries reduces intergenerational mobility and thus steepens the social gradient in natives’ labor market outcomes, whereas immigration from high-income countries levels it. These findings are robust with respect to a wide range of identifying assumptions. The analysis is based on high-quality population-wide administrative data from Norway, which is one of the rich-world countries with the most rapid rise in the immigrant population share over the past two decades. Our findings suggest that immigration can explain a considerable part of the observed relative decline in economic performance among natives with a lower-class background.

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Equity and health sector reforms: can low-income countries escape the medical poverty trap?

The Lancet ◽

10.1016/s0140-6736(01)05975-x ◽

2001 ◽

Vol 358 (9284) ◽

pp. 833-836 ◽

Cited By ~ 256

Author(s):

Margaret Whitehead ◽

Göran Dahlgren ◽

Timothy Evans

Keyword(s):

Low Income ◽

Health Sector ◽

Low Income Countries ◽

Poverty Trap ◽

Health Sector Reforms

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The Short Run Effects of Health Aid in Low Income Countries:Evidence from Panel Data Analysis

10.21203/rs.2.13239/v1 ◽

2019 ◽

Author(s):

Keneni Gutema Negeri

Keyword(s):

Health Status ◽

Panel Data ◽

Low Income ◽

Panel Data Analysis ◽

Health Sector ◽

Infant Mortality Rate ◽

Low Income Countries ◽

Health Coverage ◽

Health Aid ◽

Short Run

Abstract Background The effect of health targeted aid in developing countries is debatable. This paper examines the short run effect of health aid on health status in low income countries of the world. Method The study estimates the short run effect of health aid on health status in low income countries. Infant mortality rate was used as a proxy for health status and a panel data was constructed from 34 countries for the period between 2000 and 2017. For the estimation, first difference GMM and System GMM were employed. Results The estimation results confirm the argument that health aid has a beneficial and statistically significant short run effect on the health status of low income countries: doubling health aid saves the lives of 20 infants per 10,000 live births. Conclusion From the findings of this paper it can be concluded that health aid could be one of the best tools with which the broader health status gap currently observed between high income and low income groups, could be eliminated and hence the target of Universal Health Coverage is met. However, recipient countries need to find ways of promoting domestic factors that have favorable impact on health sector as they cannot persistently relay up on external resources.

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Estimated number of ophthalmologists worldwide (International Council of Ophthalmology update): will we meet the needs?

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2019-314336 ◽

2019 ◽

Vol 104 (4) ◽

pp. 588-592 ◽

Cited By ~ 18

Author(s):

Serge Resnikoff ◽

Van Charles Lansingh ◽

Lindsey Washburn ◽

William Felch ◽

Tina-Marie Gauthier ◽

...

Keyword(s):

Cataract Surgery ◽

Visual Impairment ◽

Low Income ◽

Care Delivery ◽

Low Income Countries ◽

Gdp Per Capita ◽

Prevalence Rates ◽

Eye Care ◽

Care Needs ◽

Per Capita

Background/aimsTo estimate 2015 global ophthalmologist data and analyse their relationship to income groups, prevalence rates of blindness and visual impairment and gross domestic product (GDP) per capita.MethodsOnline surveys were emailed to presidents/chairpersons of national societies of ophthalmology and Ministry of Health representatives from all 194 countries to capture the number and density (per million population) of ophthalmologists, the number/density performing cataract surgery and refraction, and annual ophthalmologist population growth trends. Correlations between these data and income group, GDP per capita and prevalence rates of blindness and visual impairment were analysed.ResultsIn 2015, there were an estimated 232 866 ophthalmologists in 194 countries. Income was positively associated with ophthalmologist density (a mean 3.7 per million population in low-income countries vs a mean 76.2 in high-income countries). Most countries reported positive growth (94/156; 60.3%). There was a weak, inverse correlation between the prevalence of blindness and the ophthalmologist density. There were weak, positive correlations between the density of ophthalmologists performing cataract surgery and GDP per capita and the prevalence of blindness, as well as between GDP per capita and the density of ophthalmologists doing refractions.ConclusionsAlthough the estimated global ophthalmologist workforce appears to be growing, the appropriate distribution of the eye care workforce and the development of comprehensive eye care delivery systems are needed to ensure that eye care needs are universally met.

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Low-income Countries’ Orthopaedic Information Needs: Challenges and Opportunities

Clinical Orthopaedics and Related Research ◽

10.1007/s11999-010-1365-x ◽

2010 ◽

Vol 468 (10) ◽

pp. 2598-2603 ◽

Cited By ~ 10

Author(s):

Kathryn Doughty ◽

Linda Rothman ◽

Luke Johnston ◽

Kim Le ◽

Joanna Wu ◽

...

Keyword(s):

Low Income ◽

Information Needs ◽

Low Income Countries ◽

Challenges And Opportunities

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What is ‘global surgery’? Defining the multidisciplinary interface between surgery, anaesthesia and public health

BMJ Global Health ◽

10.1136/bmjgh-2019-001808 ◽

2019 ◽

Vol 4 (5) ◽

pp. e001808 ◽

Cited By ~ 3

Author(s):

Michael Bath ◽

Tom Bashford ◽

J E Fitzgerald

Keyword(s):

Public Health ◽

Health Systems ◽

Low Income ◽

International Health ◽

Surgical Care ◽

Global Surgery ◽

Middle Income ◽

Geographical Regions ◽

Working Together ◽

Major Factors

‘Global surgery’ is the term adopted to describe a rapidly developing multidisciplinary field aiming to provide improved and equitable surgical care across international health systems. Sitting at the interface between numerous clinical and non-clinical specialisms, it encompasses multiple aspects that surround the treatment of surgical disease and its equitable provision across health systems globally. From defining the role of, and need for, optimal surgical care through to identifying barriers and implementing improvement, global surgery has an expansive remit. Advocacy, education, research and clinical components can all involve surgeons, anaesthetists, nurses and allied healthcare professionals working together with non-clinicians, including policy makers, epidemiologists and economists. Long neglected as a topic within the global and public health arenas, an increasing awareness of the extreme disparities internationally has driven greater engagement. Not necessarily restricted to specific diseases, populations or geographical regions, these disparities have led to a particular focus on surgical care in low-income and middle-income countries with the greatest burden and needs. This review considers the major factors defining the interface between surgery, anaesthesia and public health in these settings.

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