WHO is expanding its programme to train health care staff in low- and middle-income countries in essential emergency, basic surgery and anaesthesia skills.
The programme, which already exists in 22 countries, will boost the capacity of first-level health facilities (rural or district hospitals and health centres) to deal with simple but essential surgery in a growing number of developing regions.
In many cases, death and permanent disability can be avoided through simple surgical interventions following road traffic injuries, interpersonal violence or war, abdominal emergencies, pregnancy complications, congenital abnormalities, fractures, burns, or the consequences of acute infections.
Together, these conditions cause the loss of approximately 11% of total lost years of healthy life (according to the World Health Report 2002). Injuries alone kill more than 5 million people every year, accounting for nearly one in every 10 deaths worldwide.
The WHO Emergency and Essential Surgical Care Project trains health staff in simple surgical procedures, anaesthesia and emergency care. After training and with the help of basic equipment, health care staff are able to perform surgical procedures that save lives and prevent disability.
New approach to surgery
"The initiative signifies a shift in the way we think about surgery," explains Dr Luc Noel, in charge of clinical procedures at WHO. "Until recently, surgery was a neglected health issue in developing countries because it was assumed to be too expensive and sophisticated."
Surgical intervention has become a common component in the management of patients with HIV/AIDS. Some complications associated with HIV infection (such as abscesses, anorectal disorders, lymphadenopathies, lipoatrophy or mild forms of Kaposi sarcoma) are also diagnosed and treated with simple surgical interventions. Current evidence shows that basic surgical and anaesthetic services should be integrated into primary health-care packages.
"Why should a child die from appendicitis, or a mother and child succumb to obstructed labour, when simple surgical procedures can save their lives?" said Dr Meena Cherian, who heads the surgery programme at WHO.
Barriers to surgical services
The quality of emergency and essential surgical care is often constrained by inadequate basic equipment for interventions that are simple but vital, such as resuscitation, giving oxygen, assessing anaemia and inserting a chest drain.
Other barriers to the timely and appropriate delivery of basic surgical services in low- and middle-income countries include poor infrastructure and insufficient numbers (and training) of health-care professionals.
In most developing countries, adequate surgical services are found only in tertiary centres in urban areas. Furthermore, the migration of health professionals leaves a shortage at primary-health facilities, where services are provided by non-specialist or even non-medical personnel, many of whom are inadequately trained.