Nobody should be pushed into poverty for needing surgical care

By Dominique Vervoort, InciSioN — The International Student Surgical Network

A young boy is walking home from work, not able to attend school because he has to earn money to provide for his family. It’s a busy hour, when suddenly, he becomes part of a road traffic accident. Urgently needing transportation to the nearest emergency care center to receive life-saving surgery, his nation’s health care system requires him to pay out-of-pocket. This ultimately leads to the loss of the few assets his family possessed. His life has been saved, yet his family loses the already meagre life as they knew it.

For many, the story above may seem unlikely or may not concern them on any level, yet it’s the sad truth many people worldwide risk facing on a daily basis. This boy, his brother or sister, or nearest acquaintances are concerned, and so are many others, which is why InciSioN’s members unite to take action, to act with ambition, in order to not let the above situation happen again to some of their relatives or friends.

Surgery is an indivisible, indispensable part of health care” 
 — Dr. Jim Yong Kim, President of the World Bank

Currently, an estimated 5 billion people in the world lack access to safe surgical care, making operable conditions with an estimated 28–32% an important part of the global burden of disease. Even though 313 million surgical procedures take place every year, only 6% are reserved for the poorest third in the world.

Poor countries not only lack surgical groundwork; they are also subjected to disparities in its distribution. Bigger cities monopolize health care and, in many places, only the richer people can afford medical interventions. Haiti, for example, saw up to 1,400 maternal deaths per 100,000 births in some areas, solely due to the lack of ability to perform caesarian sections, whilst areas that were able to perform them had similar mortality rates as the United States. It’s exactly those situations that serve as major calls for moving national health system funding from out-of-pocket user fees to financial risk protection through universal health coverage, established through general taxation and insurance models.

Although surgical care is proven to be highly cost-effective as a health intervention (even more than previous global health priorities such as antiretrovirals for HIV/AIDS and oral rehydration therapy), it can still be catastrophically expensive for individual patients, if they have to pay out-of-pocket at the time of receiving care. A key component of access to surgery is the availability of universal health coverage and affordable health care systems, as seen in many (albeit not all) high-income countries (HICs). Nevertheless, out-of-pocket payment for surgical care occurs in many LMICs, because surgical interventions are not usually covered by publicly financed health care packages. Globally, 33 million individuals face catastrophic health expenditure due to payment for surgery and anaesthesia care each year. An additional 48 million cases of catastrophic expenditure are attributable to the non-medical costs of accessing surgical care. Many more people do not seek care at all, or decide not to pursue surgical treatment as advised, because they cannot afford the costs. The burden of catastrophic expenditure for surgery is highest in LMICs and, within any country, comes down the most to poor people.

Considering the crucial importance of access to safe surgical, anaesthetic and obstetric care for all, the need of pushing Global Surgery on the global agenda is ever so high. Universal health coverage will prove to be vital in achieving these goals, which is why nations and international leaders need to be held accountable for current health system gaps. Many of InciSioN’s members regularly witness similar stories to the one above, and therefore, we don’t just act, but act with ambition, as nobody should be pushed into poverty for needing surgical care.

Dominique Vervoort is a fifth year medical student from the KU Leuven (Belgium) and the Vice-President for External Affairs of InciSioN — The International Student Surgical Network.

InciSioN is an international network of medical students from across the world working on Global Surgery, thus contributing to achieving access to safe, surgical and anaesthesia care for all. For UHC Day, InciSioN is massively spreading the word through their extensive network, by spreading surveys, banners, articles and key facts regarding UHC.

1. Mathers CD, Loncar D (2006) Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 3(11):2011–2030
2. Weiser, TG, Haynes, AB, Molina, G et al. Size and distribution of the global volume of surgery in 2012. Bull World Health Organ. 2016; 94: 201–209
3. Jean-Louis R (1989) Diagnostic de l’état de santé en Haïti. Forum Libre I (Médecine, Santé et Démocratie en Haïti) 11–20
4. Chao, Tiffany E et al. Cost-effectiveness of surgery and its policy implications for global health: a systematic review and analysis. The Lancet Global Health. 2014; 2(6): 334–345
5. WHO, World Bank. Monitoring progress towards universal health coverage at country and global levels. May, 2014. Geneva: World Health Organization, World Bank Group, 2014.
6. Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus J, Murray CJ. Household catastrophic health expenditure: a multicountry analysis. Lancet 2003; 362: 111–17.
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