Aim of the Project

The main aim of the project is to do a baseline assessment of the current state of surgical, obstetrics and anaesthesia services and care in Nigeria and then create a road map to address identified gaps, limitations and challenges. Based on the road map, Realistic targets to address the gaps would be prioritised to guide implementation by local, state and federal governments as well as non-governmental and charitable organisation. The impact of the implemented initiatives will be monitored and evaluated periodically to ensure the targets are being met. This will help to ensure that majority of Nigerians will have access to safe and affordable treatment when they need a surgical or obstetric operation.

Reason for Fund Raising

The requested fund raising target of N5,000,000.00 is meant for the 2nd stakeholder's meeting scheduled for Ibadan in October 2017 at which 40 persons will participate. The fund will be used for flight tickets/transportation, hotel accommodation for 3 nights (meeting is for 2 full working days) and provision of refreshments, lunch and dinner during the period of the meeting. At the moment, the committee has no funding.

Background

In 2013, The Lancet initiated a process to bring together experts in clinical surgery and anesthesia, researchers, economists, and policymakers to address the state of surgery worldwide and to make concrete recommendations for its improvement. The Lancet Commission on Global Surgery (henceforth, the Commission) culminated in the release of the seminal report, Global Surgery 2030.  This report included startling findings: 5 billion people do not have access to safe, affordable, and timely surgical and anesthesia care. 143 million additional procedures are needed worldwide to meet the gap between available and necessary procedures.  At least a quarter of patients who do receive surgery are financially impoverished thus. Economic losses from burden of surgical illness amounted to almost 2% of the GDP of low and middle-income economies.

The work of the Commission clearly showed that investing in surgery (including Obstetric and Trauma care) and anesthesia is a critical component of sound economic growth. Furthermore, the work showed that strengthening Surgical, Obstetrics and Anaesthesia care ultimately leads to an overall improvement and strengthening of the entire healthcare system. The Commission recommended a pathway for countries to be able to scale up surgical access and services in a coordinated and effective manner.  This pathway, called the National Surgical Plan framework, makes concrete recommendations in five essential domains of an effective and resilient surgical system: (1) infrastructure (2) workforce (3) service delivery (4) information management and (5) financing. 

The work of the Commission and other groups, supported by Nigeria, Zambia, Rwanda and others countries, resulted in the World Health Assembly Resolution 68/15 in May 2015, to include Emergency and Essential Surgical and Anaesthesia Care as integral component of Universal Health Coverage (UHC), with specific emphasis on the integration of emergency and essential surgery and anesthesia services into UHC efforts at the primary health care and first referral hospital level, and to develop sustainable financing systems for provision of such care.. Since then, Zambia, Sierra Leone, Cape Verde and India have made significant progress in developing national surgical plans to strengthen the capacity of their healthcare systems to provide emergency and essential surgical care.

Gaps in relation to Surgical, Obstetric and Anaesthesia care

Nigeria has a maternal mortality ratio of 560/100,000 live births and an Infant mortality rate of 69/1000 live births with wide in-country variability. Nigeria met its targets in maternal mortality rate, made a strong effort with under-five mortality, but struggled with infant mortality and many other areas of the Millennial Development Goals. (Nigeria 2015 MDGs).  Life expectancy at birth m/f (years, 2015) 53/56.

In a recently published systematic review of road traffic crashes, injuries and deaths in Africa by WHO, Nigeria was reported to have the highest number of road traffic injury and death rates at 4120 per 100,000 and 160 per 100, 000 population - highest rate recorded in any single study in Africa! (Adeloye D. WHO 2016).

Currently, the state of readiness of our healthcare system to provide emergency and essential surgical and Anaesthesia care, including Obstetric and trauma care, across primary, secondary and tertiary care levels has not been ascertained. More specifically, a situational analysis to identify the gaps in infrastructure, service delivery, human resources (workforce), financing and information management, is required to ascertain the readiness, as well as provide the needed data for priority setting and implementation.

Expected Deliverables of the NSOAP

The expected deliverables include the plan include:

1. A policy brief on baseline assessment and level of readiness of our healthcare system to provide emergency and essential surgical care towards achieving UHC
2. Recommendations of essential surgical packages that should be provided at primary, secondary, tertiary levels of care
3. Recommendations for efficient referral systems within our healthcare system
4. Convening of a national surgical, Obstetric and Anaesthesia forum of stakeholders
5. National Surgical, Obstetric and Anaesthesia Plan for inclusion in National Strategic Health Plan

Current Efforts

The NSOAP committee, chaired by Professor Emmanuel Ameh (Department of Surgery, National Hospital, Abuja) (he worked with the Lancet Commission on Global Surgery as one of the commissioners and chair of the workforce, training and education working group for that commission) is working in collaboration with Federal Ministry of Health and the Program on Global Surgery and Social Change at the Harvard Medical School, Boston, United States (which led the Lancet Commission) recently brought together professionals and stakeholders for an initial meeting on 7 July 2017 at the National Trauma Centre, National Hospital, Abuja.  At this meeting, working groups were formed to begin work on various aspects of the NSOAP. The very next step is to gather existing publications and data on surgical, obstetrics and anaesthesia care in Nigeria. The stakeholders will then meet in October 2017 to evaluate the existing data and publication, and to plan the next steps.

The process is expected to be done in phases, including:

Phase 1: Baseline assessment and generation of primary data on key aspects of the healthcare system relating to surgery, Obstetrics and Anaesthesia care

Phase 2: Convening of a national forum of stakeholders to deliberate on phase 1 results, set actionable priorities for implementation and produce the NSOAP

Phase 3: Launching of the NSOAP and its integration into the National Strategic Health Plan

Phase 4: Implementation of the NSOAP and ongoing evaluation to track impact of implementation

Organisations Involved

Assosciation of Surgeons of Nigeria

American College of Surgeons, Nigeria Chapter

Trauma Professional Society of Nigeria

All Surgical Sub Specialties

Society for Gynaecology and Obstetrics of Nigeria

Nigeria Society of Anaesthetists

Significance

When completed, the NSOAP will provide a road map for scaling up surgical, obstetric and anaesthesia services in Nigeria. This will guide targetted implementation as well as ongoing evaluation of impact to ensure progressive improvements and realisation of Universal Health Coverage and Health-related Sustainable Development Goals.