As the international community moves away from long-standing volunteerism (fly-in, fly-out missions) to more sustainable, collaborative approaches to advance global surgical care, integrated frameworks are becoming increasingly important to convene all stakeholders and optimize health system interventions. One such approach are National Surgical, Obstetric, and Anaesthesia Plans (NSOAPs), a framework put forward by the Lancet Commission on Global Surgery as a response to the findings that five billion people lack access to safe surgical care when needed. The framework addresses five crucial domains (infrastructure, service delivery, workforce training and education, information management, and financing) to be integrated in national health plans focused on surgical capacity and access in a country.
During the 70th World Health Assembly (WHA) in May 2017 in Geneva, Switzerland, Zambia was the first country in the world to launch an NSOAP, integrated in its National Health Plan 2017-2021. Inspired by Zambia’s work, Papua New Guinea and Tanzania followed in the months that came after, with many other countries in process of starting or completing the creation of their individual NSOAPs.
Figure 1.: National Surgical, Obstetric, and Anaesthesia Plan (NSOAP) Framework (1)
National plans innately build upon what’s in place, and therefore require a baseline assessment of a country’s surgical system, from the pre-hospital chain to post-hospital follow-up and care, assessed through the six LCoGS indicators: two-hour access to a facility providing surgical care, surgical workforce density, surgical volume, perioperative mortality rate, protection against impoverishing expenditure, and protection against catastrophic expenditure. In addition, on the ground collaboration with local stakeholders, including the Ministry of Health, professional societies, healthcare professionals, civil society, and private and non-state sectors, is essential for fruitful progress and implementation of plans, addressed in a contextual and country-specific way, rather than an all-size-fits-all approach. Accordingly, NSOAPs form an inclusive and integrated policy document guiding a country and holding it accountable to scale up surgical care delivery for the entirety of its population in its efforts towards universal health coverage. Over time, NSOAPs are monitored and evaluated to ensure efficient use of resources and the provision of care, and maximize effects to promote the economic prosperity of the population and the nation as a whole.
To fully address health issues in, especially, low- and middle-income countries (LMICs), integration of cardiac surgical care, as many other subspecialties, will prove crucial. Despite the complexity of cardiac procedures, the need is ever so high, underlined by the global burden of cardiac disease. With 17.5 million deaths each year and 80% occurring in LMICs, cardiovascular diseases form the leading disease cause of mortality in the world. Although prevention is crucial to address this, holistic approaches to reduce mortality and morbidity will have to be built on interventional and surgical care. Creating a framework in which cardiac surgical services, from infrastructure to delivery, are optimized, will require increasing recognition across sectors, but impact hospital-wide settings.
Further Reading:
World Health Organization, 2017 – Surgical Care Systems Strengthening: Developing National Surgical, Obstetric, and Anaesthesia Plans: http://apps.who.int/iris/bitstream/handle/10665/255566/9789241512244-eng.pdf?sequence=1&isAllowed=y
Harvard Program in Global Surgery and Social Change (PGSSC) – National Surgical Planning: https://www.pgssc.org/national-surgical-planning
Global Cardiac Surgery 