National Surgical, Obstetric and Anesthesia Planning for High-Level Global, Regional, and Country Authorities and Funders
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PROCEEDINGS National Surgical, Obstetric and Anesthesia Planning for High-Level Global, Regional, and Country Authorities and Funders http://ghd-dubai.hms.harvard.edu PROCEEDINGS Copyright 2019 by the Harvard Medical School Center for Global Health Delivery–Dubai. All rights reserved. Publications of the Harvard Medical School Center for Global Health Delivery–Dubai are available at www. ghd-dubai.hms.harvard.edu. Printed publications can also be requested at [email protected]. Any opinion, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of Harvard Medical School. Harvard Medical School or its licensors at all times own and retain all right, title, and interest in and to these Proceedings (hereafter referred to as “the publication”) including all intellectual property rights therein and thereto. 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International Standard Book Number ISBN-10: 1-944302-18-2 ISBN-13: 978-1-944302-18-4 Suggested citation: National Surgical, Obstetric and Anesthesia Planning for High-Level Global, Regional, and Country Authorities and Funders. Proceedings of the Harvard Medical School Center for Global Health Delivery–Dubai. 2019, Dubai, United Arab Emirates. National Surgical, Obstetric and Anesthesia Planning for High-Level Global, Regional, and Country Authorities and Funders National Surgical, Obstetric and Anesthesia Planning for High-Level Global, Regional, and Country Authorities and Funders Proceedings Rapporteur Anna Nicholson Editors Lina Roa, Alexander W. Peters, John G. Meara Harvard Medical School Center for Global Health Delivery–Dubai March 20-21, 2019 National Surgical, Obstetric and Anesthesia Planning for High-Level Global, Regional, and Country Authorities and Funders Contents Executive Summary 12 1 Introduction 16 1.1 Workshop aims and objectives 17 1.2 Organization of the workshop and the proceedings 17 2 The case for NSOAPs: current landscape and theoretical frameworks 19 2.1 A banner year for global surgery in 2015 19 2.2 The evolution of global surgery (1980-2019) 19 2.3 The Lancet Commission on Global Surgery 20 2.3.1 Key message: lack of global access to surgical and anaesthesia care 21 2.3.2 Key message: additional surgical procedures needed 23 2.3.3 Key message: financial risk protection 24 2.3.4 Key message: the case for investment in surgery 24 2.3.5 Key message: surgery, obstetrics and anaesthesia is an indivisible and indispensable part of health care 24 2.3.6 Global surgery indicators 24 2.3.7 National surgical, obstetric, and anaesthesia plans 25 2.3.8 Discussion 26 2.4 Macroeconomics of surgical care: the cost of doing nothing 27 2.4.1 Economic welfare perspective 27 2.4.2 Economic output perspective 27 2.4.3 Estimating the macroeconomic burden of disease 27 2.4.4 Value of lost welfare model 29 2.4.5 Discussion 30 2.5 The NSOAP process: theoretical framework 31 2.5.1 Ministry of health leadership 31 2.5.2 Situation analysis and baseline assessment 32 2.5.3 Stakeholder engagement and priority setting 32 2.5.4 Drafting and validation 33 2.5.5 Monitoring and evaluation 33 2.5.6 Costing 34 2.5.7 Governance framework 34 2.5.8 Implementation 34 2.5.9 Discussion 34 5 3 Global-level NSOAP mandates and activities 35 3.1 NSOAPs and WHO HQ: progress on WHA 68.15 and the role of WHO 35 3.1.1 Essentials of WHA68.15 35 3.1.2 WHO’s current priority projects 36 3.1.3 Ways forward for global surgery efforts 39 3.1.4 Discussion 40 3.2 WHO Regional Offices and the NSOAP process 40 3.2.1 Overview of the WHO EMRO Region 41 3.2.2 NSOAPs in the EMRO Region 41 3.2.3 WHO support in developing funding for NSOAPs 42 3.2.4 NSOAPs and people-centered health services 42 3.3 Global surgical indicator tracking: progress, challenges and opportuni- ties 43 3.3.1 World Bank’s World Development Indicators 43 3.3.2 Global surgical indicators in the Pacific Region 46 3.3.3 Assessment of the strength of Pakistan’s surgical system: tracing the LCoGS indicators 47 3.3.4 Discussion 48 3.4 Working with the World Bank to promote NSOAPs globally 50 3.4.1 Engaging with the World Bank in SOA planning 51 3.4.2 Human capital: the crisis 51 3.4.3 Summary 55 3.5 Role of professional societies in NSOAPs 56 3.5.1 World Federation of Societies of Anaesthesiology 56 3.5.2 International Federation of Gynecology and Obstetrics 60 3.5.3 Broadening access to care for women with limited social rights 62 3.5.4 Discussion 65 4 NSOAP financing and resource mobilization 66 4.1 Developing an NSOAP financial strategy 66 4.1.1 NSOAP financing and the NSOAP process 66 4.1.2 Components of an NSOAP financial strategy 66 4.1.3 Policy options for NSOAP financial strategy 68 4.1.4 Discussion 69 4.2 Mobilizing global resources for NSOAPs 70 4.2.1 Spanish Agency for International Development Cooperation 70 4.2.2 Korea International Cooperation Agency and NSOAP partnership 71 National Surgical, Obstetric and Anesthesia Planning for High-Level Global, Regional, and Country Authorities and Funders 4.2.3 USAID surgical programming 72 4.2.4 Making the investment case for NSOAPs 75 4.2.5 Discussion 76 4.3 WHO resources for emergency and trauma care implementation 79 4.3.1 Global burden of injury-caused mortality 79 4.3.2 Need for low-resource, high-impact interventions 80 4.3.3 Aligning emergency and surgical care with global mandates 81 4.3.4 Emergency care system framework 82 4.3.5 WHO Emergency and Trauma Care System Assessment 83 4.3.6 WHO International Registry for Trauma and Emergency Care 84 4.3.7 Discussion 84 5 NSOAP progress in regions and countries 86 5.1 Regional approach to NSOAP development: the SADC Resolution 86 5.1.1 Timeline of regional SOA planning for SADC 87 5.1.2 SADC Health Protocol 88 5.1.3 Progress, challenges, and next steps in the SADC region 88 5.1.4 Discussion 89 5.2 Milestones in NSOAP development and implementation in Africa 89 5.2.1 Building blocks of NSOAPs 90 5.2.2 Namibia 91 5.2.3 Rwanda 93 5.2.4 Zambia 93 5.3 Discussion 94 5.3.1 Opportunities for regional coordination 94 5.3.2 Avoiding duplication and overlap 95 5.3.3 Return on investment 95 5.3.4 Galvanizing public support for NSOAPs 96 5.4 Adapting the NSOAP framework to the local context: experience in Paki- stan 96 5.4.1 Surgical care delivery: the Indus experience 96 5.4.2 State of health care in Pakistan 97 5.4.3 Surgical care deficit in Pakistan 98 5.5 Pakistan’s National Vision for Surgical Care 2025 98 5.5.1 Challenges in surgical care delivery in Pakistan 99 5.5.2 Discussion 100 5.6 The way forward in South Asia 100 5.6.1 Indonesia 100 5.6.2 Malaysia 101 5.6.3 Myanmar 101 5.6.4 Sri Lanka 102 5.6.5 Nepal 102 5.6.6 Cambodia 103 5.6.7 Vietnam 103 5.6.8 Laos 103 5.6.9 Bangladesh 103 5.6.10 Next steps 104 5.7 The way forward in the South Pacific 104 5.7.1 Fiji 105 5.7.2 Papua New Guinea 106 5.7.3 Solomon Islands 106 5.7.4 Ways forward in the region 107 5.7.5 Analysis of NSOAP progress in the region 107 5.7.6 Discussion 109 5.7.7 Engaging with WHO Regional office 109 5.7.8 Regional professional associations 109 5.7.9 Next steps to promote NSOAP development 109 References 111 Appendices 114 Appendix 1: Workshop Agenda 115 Appendix 2: Workshop Participants 119 Appendix 3: Example of World Bank Group promotion of global surgery indicators 148 Appendix 4. Simulation model for developing human capital for health 149 Appendix 5.