Essential Surgery: Key Messages of this Volume

Authors: Charles Mock, Peter Donkor, Atul Gawande, Dean Jamison, Margaret Kruk, Haile Debas


Essential Surgery reflects an increased emphasis on health systems relative to previous editions of Disease Control Priorities. This volume identifies 44 surgical procedures as essential on the basis that they address substantial needs, are cost-effective, and can feasibly be implemented. This chapter summarizes and critically assesses the volume’s key findings:

  • Provision of essential surgical procedures would avert an estimated 1.5 million deaths a year, or 6 percent to 7 percent of all avertable deaths in low- and middle-income countries (LMICs).
  • Essential surgical procedures rank among the most cost-effective of all health interventions. The surgical platform of first-level hospitals delivers 28 of the 44 essential procedures, making investment in this platform also highly cost-effective.
  • Measures to expand access to surgery, such as task-sharing, have been shown to be safe and effective while countries make long-term investments in building surgical and anesthesia workforces. Because emergency procedures constitute 23 of the 28 procedures provided at first-level hospitals, such facilities must be widely geographically available.
  • Substantial disparities remain in the safety of surgical care, driven by high perioperative mortality rates and anesthesia-related deaths in LMICs. Feasible measures, such as the World Health Organization’s (WHO’s) Surgical Safety Checklist (WHO 2008a), have led to improvements in safety and quality.
  • The large burden of surgical conditions, the cost-effectiveness of essential surgery, and the strong public demand for surgical services suggest that universal coverage of essential surgery (UCES) should be financed early on the path to universal health coverage. We point to estimates that full coverage of the component of UCES applicable to first-level hospitals would require slightly more than $3 billion annually of additional spending and yield a benefit:cost ratio of better than 10:1. It would efficiently and equitably provide health benefits and financial protection, and it would contribute to stronger health systems.


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