Available online 20 November 2023, 151347

Author links open overlay panel, Abstract

An estimated two-thirds of the world's children and adolescents, most of whom live in low- and middle- income countries lack access to safe, quality, and timely surgical care. While much efforts have been made in the last decade to advocate for children’ surgery, several economic and policy gaps remain, hampering progress and investments. These gaps range from lack of adequate data on costs and cost-effectiveness, high rate of out-of-pocket payments and limited health insurance coverage, to non-inclusion of children's surgical care in public child health policies and surgical plans. Given the magnitude of the limitations, actions and initiatives need to be prioritised to facilitate coordinated investments. Urgent investments are required to generate reliable and convincing data on costs of children's surgical care, as well as costs of equipment and supplies. To support actions and initiatives, children's surgery should be included in any existing and planned child public health initiatives and surgical plans. Integration of injury prevention and early identification of surgical conditions into school health initiatives would also strengthen care. The overall return on investment in children's surgical care are enormous with implications for child survival, family, and society stability as well as country workforce and economy. Investments should be well coordinated at country, regional and global levels to avoid waste of resources and duplication of efforts, while encouraging convergence of efforts.

Section snippetsINTRODUCTION

It was estimated that as of 2017, 1.7 billion children and adolescents worldwide lacked access to surgical care, with 92.3% and 97.7% of children in lower-middle- and low-income countries respectively lacking access to surgical care1. The implications of these figures and the enormity of the burden become more apparent when they are considered against the backdrop that children and adolescents constitute up to half of the population in many low- and middle-income countries where over 80% of the

Costs

A key barrier to investments in surgery as a whole and children's surgery specifically is the prevailing wrong notion that it is too complex and expensive with limited economic benefits4. This has continued to hinder its inclusion in global health efforts and programs. The fact that children are unique and differ from adults indicate investments in improving infrastructure, equipment and human resources for children's surgical care need to be done in a focused, specific and intentional manner.

The gaps

Evidence of the economic value, societal benefits and cost-effectiveness of children's surgery are extremely useful as strong advocacy tools for policymakers and funders to invest in scaling up care5,18. Quantifying the economic value of surgery provides a robust argument for strengthening the role of global surgery in achieving the goals of global health7. It also serves to guide policy makers in making resource allocation decisions and future decisions on enhancing paediatric surgical capacity

References (23)B Hooley et al.Health insurance coverage in low-income and middle-income countries: progress made to date and related changes in private and public health expenditure

BMJ Glob Health

(2022)

View full text

© 2023 Elsevier Inc. All rights reserved.