Development of a Unifying Target and Consensus Indicators for Global Surgical Systems Strengthening: Proposed by the Global Alliance for Surgery, Obstetric, Trauma, and Anaesthesia Care (The G4 Alliance).

After decades on the margins of primary health care, surgical and anaesthesia care is gaining increasing priority within the global development arena. The 2015 publications of the Disease Control Priorities third edition on Essential Surgery and the Lancet Commission on Global Surgery created a compelling evidenced-based argument for the fundamental role of surgery and anaesthesia within cost-effective health systems strengthening global strategy. The launch of the Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care in 2015 has further coordinated efforts to build priority for surgical care and anaesthesia. These combined efforts culminated in the approval of a World Health Assembly resolution recognizing the role of surgical care and anaesthesia as part of universal health coverage. Momentum gained from these milestones highlights the need to identify consensus goals, targets and indicators to guide policy implementation and track progress at the national level. Through an open consultative process that incorporated input from stakeholders from around the globe, a global target calling for safe surgical and anaesthesia care for 80% of the world by 2030 was proposed. In order to achieve this target, we also propose 15 consensus indicators that build on existing surgical systems metrics and expand the ability to prioritize surgical systems strengthening around the world.

The cost-effectiveness of orthopaedic clinical officers in Malawi.

BACKGROUND: In Malawi the orthopaedic clinical officer (OCO) training programme trains non-physician clinicians in musculoskeletal care. We studied the cost-effectiveness of this program. METHODS: Hospital logbooks were reviewed for data pertaining to activity in seven district hospitals over a 6-month period. The total costs were divided by the total effectiveness, calculated as disability adjusted life years (DALYs) averted. RESULTS: The total cost-effectiveness of providing orthopaedic care through the OCO training programme was US$92.06 per DALY averted. The mean per hospital was US$138.75 (95% CI: US$69.58-207.91) per DALY averted which is very cost-effective when compared with other health interventions. Of the 837 patients treated 63% were aged <15 years and 36% were in the 'economically active' demographic of ages 15-74 years. CONCLUSION: Training of clinical officers in orthopaedic surgery is very cost-effective and allows transfer of skills into rural areas. The demographics suggest that failure to provide such care would have a negative economic impact.

Scoliosis screening revisited: findings from the District of Columbia.

The authors performed a retrospective review of scoliosis screening data collected by school health nurses annually from 1985 to 1996. The data collected included 20 variables for all in the sixth and eighth grades and follow-up data for a portion of the referred students in the District of Columbia's public schools. During the school years 1989 to 1990 and 1995 to 1996, 52,300 students were screened for scoliosis. Of those screened, only 1,218 (2%) were referred for further evaluation. Only 47% of these students reported for care. Only 223 students (18%) provided any definitive information on the type of care or degree of curve. Findings indicate that many of the referred cases are never followed up. Thus, it is difficult to know the true prevalence of scoliosis or types of treatments provided in this population. Although the District of Columbia is modest in its referral rate, students referred are not being tracked for further diagnosis or treatment.

Physicians and surgeons volunteering in developing countries: a personal perspective.

After a physician volunteers in the developing world, his or her eyes open to vast problems. There are many opportunities for physicians to volunteer in developing countries. Medical personnel should know the major agencies that send volunteers and understand how their actions help in disaster relief, direct patient care, or teaching. Volunteers should work with major established organizations to ensure they are not more of a burden than a help. Individuals assisting in training, development, or human rights investigations can change the world by their efforts.