Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Landmark Day for Global Surgery: World Health Assembly recognises surgery and anaesthesia as fundamental to universal healthcare

22 May 2015
1.5 million lives could be saved per year
Today (22 May 2015), Ministers of Health from around the world approved the World Health Organisation (WHO) Resolution 68/31  on Strengthening Emergency and Essential Surgical Care and Anaesthesia  at the Sixty-Eight World Health Assembly , which recognises that surgery and anaesthesia are fundamental to achieving universal health coverage . 
Speaking about this landmark Resolution, RCSI (Royal College of Surgeons in Ireland) President Mr Declan J. Magee said:  “RCSI has long been aware of the need to ensure that access to safe surgery and support for quality training programmes are on the agenda of health ministries. We are pleased to have played our part in getting this matter onto the global stage. RCSI will continue to work with our partners in Africa to meet the targets set out under this important Resolution.”
Addressing a delegation of African Health Ministers attending the WHA in Geneva, Mr Magee urged ministries to provide direct funding for domestic surgical training initiatives. This support is critical to the long-term sustainability and success of surgical training institutions in Sub-Saharan Africa, one of which, the College of Surgeons of East, Central and Southern Africa (COSECSA) has been a long-term partner of RCSI. 
Mr Magee highlighted the success of RCSI’s partnership with COSECSA and other global healthcare initiatives  and noted that RCSI has been instrumental in raising the profile of COSECSA internationally, including at the WHA. Such efforts have helped to raise awareness of the substantial challenges facing surgeons in the region, particularly those in rural areas, and has helped to bring about advances such as the new Resolution . Mr Magee underlined to Ministers that this Resolution constitutes a unique opportunity and encouraged Ministries to allocate time and resources to honour their commitment to improved surgery and anaesthesia care.

The impact of sufficient support for surgical and anaesthesia care, as set out under the Resolution, was recently highlighted in The Lancet :

  • 1·5 million deaths per year could be averted, representing 6·5% of all avertable deaths in these countries.
  • Essential surgical procedures rank among the most cost effective of all health interventions. 
  • The large burden of surgical disorders, cost-effectiveness of essential surgery, and strong public demand for surgical services suggest that universal coverage of essential surgery should be financed early on the path to universal health coverage. 
  • Full coverage of the component of universal coverage of essential surgery applicable to first-level hospitals would require just over US$3 billion annually of additional spending and yield a benefit–cost ratio of more than 10:1. It would efficiently and equitably provide health benefits, financial protection, and contributions to stronger health systems.
Efforts to achieve these targets will be greatly improved by this Resolution which requires that Member States “expand efforts to close gaps, in both infrastructure and human resources for essential and emergency surgical care. Improving workforce distribution, with special attention being given to rural areas, should be a priority, although regular assessment and assuring the availability of functioning equipment and medicines are also essential.”  
This commitment by Health Ministries significantly advances the global development agenda. It underlines that surgical, obstetric, trauma, and anaesthesia care has a crucial role to play in fulfilling Millennium Development Goals 1, 3, 4, 5, 6, as well as the Post-2015 Sustainable Development Agenda, and achieving Universal Health Coverage (UHC). 
This Resolution follows long-standing advocacy efforts by RCSI and the wider healthcare community, and underpins the urgent need for universal access to safe, essential surgical, obstetric, trauma and anaesthesia care. Long-term capacity development and surgical training programmes such as those implemented by RCSI are fundamental to addressing the ambitious objectives set out under this Resolution, which in turn will potentially help save millions of lives in low- to middle-income countries.


Editors Notes
i. A resolution is a formal text adopted by a United Nations (UN) body such as the WHO to which Member States agree. 

ii. The full text of the Resolution 68/31 is available here: 
iii. The World Health Assembly is the decision-making body of WHO. It is attended by delegations from all WHO Member States and focuses on a specific health agenda prepared by the Executive Board. The main functions of the World Health Assembly are to determine the policies of the Organization. The Health Assembly is held annually in Geneva, Switzerland. The Irish Ministry of Health is a member of the WHA.
iv. Members States who took the floor from COSECSA countries included: Zimbabwe, Ethiopia and Rwanda. Other Member State representatives who provided statements were from Chinese Taipei, Egypt, Jordan, Haiti Indonesia and The Cook Islands. The International Federation of Surgical Colleges and World Federation of the Societies of Anaesthesiologists also made statements endorsing the Resolution. Dr. Emmanuel Makasa (Zambia) who heads of the Inter-Governmental Chair on the Resolution and is also a COSECSA Fellow stated that there was global consensus by Governments on the adoption of the Resolution.
v. RCSI Global Healthcare initiatives include the RCSI-COSECSA Collaboration Programme and COST Africa. Since 2008, the Government of Ireland through its development agency Irish Aid has provided significant support to RCSI to advance surgical care and training in Sub-Saharan Africa. RCSI in turn provides for staff and resources including curricula, education tools, skills training, examination, accreditation and quality assurance processes. The aim of the Programme is to increase the provision of quality, essential surgical and emergency care in the COSECSA region, particularly at district level, by building capacity in COSECSA.

vi. RCSI currently supports COSECSA to provide essential surgical training to clinicians in district hospitals in Zimbabwe, Zambia and Rwanda. This programme is key to improving surgical care in remote areas where surgeons are often in short supply. 

vii. Recent findings by key global health experts published in The Lancet   highlight the substantial impact of universal surgical and anaesthetic care as set out under this Resolution: See The Lancet ‘Essential Surgery: Disease Control Priorities’ , February 2015

viii. WHA Resolution on Surgery And Anaesthesia Text: