Department of Research, Kids Operating Room, Edinburgh, UK
Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK.
BMJ Paediatr Open. 2023 Feb;7(1). doi: 10.1136/bmjpo-2022-001603.
Successful health systems comprise good outcomes, accessibility and availability. Surgery is the service that cuts across many treatment scenarios, yet in low- and middle-income countries 90% of people cannot access it. Estimates using most recent population data suggest that 1.75 billion children lack access to surgical care. Additionally, 30% of the global burden of disease is treatable with surgery, yet in LMICs as much as 87% of the surgical need remains unmet. Paediatric surgical services are not at the level they need to be, highlighting an increasing surgical burden on children’s health globally with a human cost of morbidity and mortality. Achieving Universal Health Coverage and the Sustainable Development Goals will fail if surgical systems are not strengthened in low resource settings. In 2018, global health charity Kids Operating Room was founded with a goal of ensuring every child has access to the surgery they need. The charity has a four-pillar approach to its work: provision of infrastructure and equipment, paediatric surgical workforce training, database development and research capacity strengthening, and advocating on behalf of children denied access to safe surgery. To ensure that paediatric surgical interventions produce real impact on service delivery, contextual understanding and needs assessment are key. The building of paediatric surgical capacity should align to countries’ priorities and wishes. Investing in local health workforce is essential to delivering quality services, supporting resilient health systems and provides integrated, people-centred health services. A competent surgical information system gives the local surgical workforce the tools needed to action evidence-driven decisions. Strengthening surgical services in a manner aligned to the WHO’s fundamental health system building blocks, allows for sustainable and long-lasting change. Confronting bottlenecks that exist in surgical services and establishing multi-faceted development, will allow global, national and local surgical targets to be met.
成功的卫生系统包含良好的结果、可及性和可获得性。外科是贯穿许多治疗场景的服务，但在低收入和中等收入国家，90%的人无法获得它。根据最新的人口数据估计，有 17.5 亿儿童无法获得外科护理。此外，全球 30%的疾病负担可以通过手术治疗，但在中低收入国家，高达 87%的手术需求未得到满足。儿科外科服务水平尚未达到应有的水平，这突显了全球儿童健康面临的手术负担不断增加，给儿童带来了发病率和死亡率的高昂代价。如果在资源匮乏的环境中不加强外科系统，实现全民健康覆盖和可持续发展目标将无法实现。2018 年，全球健康慈善机构“儿童手术室”成立，目标是确保每个孩子都能获得所需的手术。该慈善机构的工作有四个支柱：提供基础设施和设备、儿科外科劳动力培训、数据库开发和研究能力建设，以及代表被剥夺安全手术机会的儿童进行倡导。为了确保儿科外科干预措施对服务提供产生真正的影响，了解背景和需求评估是关键。建立儿科外科能力应与国家的优先事项和愿望保持一致。投资于当地卫生劳动力对于提供优质服务、支持有弹性的卫生系统以及提供综合、以人民为中心的卫生服务至关重要。一个有能力的外科信息系统为当地外科劳动力提供了采取循证决策所需的工具。按照世卫组织基本卫生系统建设模块的要求加强外科服务，可以实现可持续和持久的变革。应对外科服务中存在的瓶颈，并建立多方面的发展，将使全球、国家和地方的外科目标得以实现。
