67. Surgery

Abstract

No matter how successful prevention strategies are, surgical conditions will always account for a significant portion of a population's disease burden, especially in developing countries. Surgically treatable conditions, which sometimes lead to life–threatening complications, take a serious human and economic toll, making productive employment impossible and imposing dependence on family members and society.

Although data for the developing world are scarce, it is clear that the burden of surgically treatable conditions is higher here than in the developed world. Surgical intervention can be cost–effective and serve priority public health goals, instead of being traditionally considered as the extreme end of the curative medical model. For example, timely initial surgical treatment can help prevent death and chronic disability from injuries as well as from a wide range of abdominal conditions; timely surgical intervention in cases of obstetrical complications can help reduce maternal and neonatal mortality; and surgical care of such conditions as cataracts, otitis media, clubfoot, and hernias can have a significant impact on quality of life.

The provision of surgical services requires organizational coordination across all levels of the health care system. In Sub–Saharan Africa and South Asia, where disease burden is particularly high, providing surgical services at the district hospital level may be the most cost–effective option. In other regions, surgical treatment in low–tech community hospitals can be cost–effective, especially in view of the significant number of surgical procedures, such as cesarean sections, that can be successfully performed by surgical technicians. Despite the challenges posed by limited resources and infrastructure, developing countries would do well to boost their investment in surgical services as a way to improve health outcomes in general.