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Children's futures hinge on investing in surgical care now

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By Garreth Wood, Founder, Kids Operating Room

We are all invested in a world where children should survive and thrive irrespective of where they are born, live, and grow up. 

As a sector, we have a deep understanding that newborn, child, and adolescent health is critical to a country’s socioeconomic development. 

We have advocated and financially invested in many crucial interventions to ensure children's health and well-being, from optimal maternal healthcare, preterm birth care, nutrition, and immunisation – but the glaring gap is still surgical care

An estimated 1.75 billion children do not have equitable and timely access to safe and affordable surgical care when needed. 

Up to 70% of these children live in countries classified as low- and middle-income countries (LMIC), some fragile and conflicted, many already grappling with weak health systems. 

We know that up to 80% of the children in need of surgical care are less than five years of age with a range of surgically amenable ailments such as congenital anomalies and childhood cancers. 

Up to 85% of older children will need surgical care of some form by age 18 from a long list of conditions, including injuries such as burns and fractures and general surgical conditions such as appendicitis. 

More than 90% of the burden of surgical disease and inequitable access to surgical care falls on countries grappling with a disproportionate rate of under-five mortality. 


Historically, mass surgical care provision in these countries was left to intermittent medical missions and camps. However, recently organisations such as Kids Operating Room, Smile Train, and the Global Initiative for Children's Surgery have pivoted from this 'parachute' model of surgical care. The emphasis is on strengthening the healthcare system to ensure timely diagnosis; quality, safe, and affordable surgery; and optimal immediate and longer post-surgical care outcomes across essential and emergency paediatric surgical care.

Paediatric surgical care is unique because there is a ready platform to deliver this much-needed care. Thanks to prior investments in global child health by actors such as the World Health Organization (WHO), UNICEF, Save the Children, Bill and Melinda Gates Foundation.  The many maternal, newborn and child health (MNCH) programmes in low- and middle-income countries have emphasised multisectoral aspects of primary health care, such as emergency triage, emergency obstetric and newborn care in addition to water, sanitation, and hygiene (WASH). 

All these sectors are central to paediatric surgical care too.  Additionally, these MNCH programmes have been premised on various health systems strengthening interventions such as growing the health workforce, improving the health systems infrastructure, health information systems and policy leadership for MNCH.  In fact, as many global surgery advocates debated the 76th World Health Assembly's (WHA) recent resolution on emergency, critical and operative care versus the landmark 68th WHA resolution on strengthening emergency and essential surgical and anaesthesia care. 

Some of us emphasised the opportunity to leverage current system investments in global child health to realise the aspirations of both resolutions. There are three strategic areas of investment into surgical care for child health; partnerships, integration of health services and advocacy. Global paediatric surgery organisations should invest in partnerships and harness shared value. This will prevent fragmentation and enable the pooling of resources and expertise. 

The interventions arising from these partnerships should be aligned with countries health priorities and a health systems strengthening approach. Paediatric surgical care must be integrated with other life-saving child health interventions. Integrated healthcare services ensure timely diagnosis, coordinated referral, treatment access and optimal patient outcomes for newborns and under fives. 

Lastly, global paediatric surgery and anaesthesia organisations should invest in advocacy because policy change only occurs with advocacy. Surgical care was prominently featured at the recently concluded 76th World Health Assembly (WHA), including in discussions on universal health coverage (UHC), non-communicable diseases, and health emergency preparedness and resilience. WHA delegates even adopted the resolution on emergency, critical and operative (ECO) care, highlighting the criticality of ECO services in these areas. 

The time to invest in surgical care is now – the world does not have time to waste. 

The global paediatric surgery community has an opportunity, in the aftermath of surgical care featuring prominently at the 76th WHA, to direct discussions towards the return on investment into this key area of health systems. 

Kids Operating Room urge for a focus on reorienting health systems towards primary health care for universal health coverage (UHC), non-communicable diseases (NCDs), health emergency preparedness and resilience (HEPR).  

Surgical care and its system strengthening has already been shown to be a cost-effective, cross-cutting treatment modality that is central to comprehensive strengthening of health systems overall. 

A strengthening of the health system is critical to resilience amidst health emergencies and pandemics. The global health community should harness this opportunity post haste to invest in the ‘staff, stuff, space, and systems’ needed to deliver much needed and life-saving surgical care. The world will only realise comprehensive newborn, child, and adolescent health and, in turn, meet critical global health and development targets with investment in surgical care.  

In the complex landscape of global health, this is a simple, proven solution. A failure to act will deny countless children their rights to play, to education, to future employment and in too many cases, to life itself.

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