Conclusions
The inclusion of this chapter indicates the evolving appreciation that surgery has a role to play in public health strategies. Previous concerns that surgery is a curative intervention performed in expensive, high-tech hospitals precluded appreciation of the potential role of surgery in public health. Public health specialists now recognize not only that surgery has a preventive role, but also that surgical treatment provided in low-tech community hospitals is cost-effective. In addition, a significant number of surgical procedures, including cesarean sections and other abdominal operations, can be successfully performed by surgical technicians (Jamisse and others 2004; Pereira and others 1996).
Surgery has an important role as a public health strategy in at least four areas:
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in the prevention of death and chronic disability in injured patients by the provision of timely, expert, and complete initial surgical treatment
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in the timely surgical intervention in obstructed labor, in pre-and postpartum hemorrhage, and in other obstetrical complications
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in the provision of competent surgery to treat a wide range of emergency abdominal and nonabdominal conditions
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in the surgical care of several elective conditions that have a significant effect on the quality of life, such as cataract, otitis media, clubfoot, hernias, and hydroceles.
Few published data are available to enable reliable estimates of either the burden of surgical diseases or the cost-effectiveness of surgical treatments in a region-specific manner to help policy makers and voluntary groups. This area merits a great deal of attention in relation to research and development. Nevertheless, the clear conclusion is that surgery must be considered a public health priority.
Notes
1. This structure is based on the authors' personal experiences of practicing in developing countries. We have defined surgical cases to include deliveries and cesarean sections.
2. For example, operating room costs are based on the results of a single study by Shepard and others (1993).
