Surgical NGOs play a crucial role in universal healthcare
The COVID-19 pandemic has eroded and exposed fragile health systems globally. Surges in patient demand have devoured limited resources, stretched tenuous supply chains and thinned already inadequate human resources.
Sadly, essential surgical services that were already in strikingly short supply, especially in low- and middle-income countries (LMICs), have further been exacerbated by the pandemic. A paradigm shift is needed to move from reactive to proactive health care systems if we are to achieve the U.N.’s lofty objectives for the Sustainable Development Goals and universal health coverage by 2030. Surgical nongovernmental organizations (NGOs) must play a key role in achieving these goals.
COVID-19 has directly led to significant disruptions in surgical care. Data from 112 countries shows that half are operating well below 70 per cent of their baseline surgical volume with the greatest reduction in low-income countries. These interruptions have mostly been justified, as evidence from the Lancet has shown that half of patients who become infected with COVID-19 before or after surgery develop pulmonary complications and are more likely to die after an operation.
Prior to the pandemic, more than 100 million additional surgical procedures were needed annually in LMICs. Current surgical delays exacerbate this unmet need: Even more mothers needing cesarean sections due to obstructed labor, more children needing their appendix removed due to infection, and more people requiring trauma surgery to repair severely fractured bones are without access to life-saving procedures.
Tragically, these and millions of others are at risk of death or disability because health systems lack adequate infrastructure and skilled workforces to address the surgical needs of their people.
Traditionally, investing in surgical systems was thought to be too expensive, too complex or too daunting. However, many essential surgical services are among the most cost-effective health services as highlighted by the World Bank’s Disease Control Priorities, Vol. 3.
Moreover, as shown by the Lancet Commission on Global Surgery, we now know that reliable surgical infrastructure can strengthen an entire health system, promote economic productivity, and create resilience in the face of unexpected disruptions like COVID-19. Unfortunately, in countries where those investments are most needed, progress has been slow.
In 2015, the World Health Assembly (WHA) unanimously passed resolution 68.15 and, for the first time, recognized emergency and essential surgical care and anesthesia as an integral part of universal health coverage. Dr. Tedros Adhanom Ghebreyesus, Director General of the World Health Organization (WHO) stated that “no country can achieve universal health coverage unless its people have access to safe, timely and affordable surgical services.”
Several countries including Tanzania, Zambia, Pakistan, Ethiopia and others are developing and implementing National Surgical Obstetric and Anesthesia Plans (NSOAPs) to begin implementing the WHA resolution at the country level.
Despite these meaningful efforts, WHA resolution 68.15 and NSOAPs have yet to transition from policy into action in a meaningful and sustainable manner.
Surgical NGOs, with their direct links to communities and policy makers, are well-positioned to enact these policies. They can and must take a leading position in supporting, advocating for and implementing surgical systems strengthening policies globally.
Working alongside local stakeholders, surgical NGOs will need to expand their services to include infrastructure development for hospitals, research capacity and training local surgical providers. This approach strengthens the overall health system rather than solely focusing on surgeries for a specific patient population.
Some notable examples include KidsOR, which has been able to outfit 25 pediatric operating rooms in 11 countries; LifeBox, which has provided more than 22,000 pulse oximeters to over 100 countries; and Jhpiego, an organization that has trained over 275,000 health care workers globally.
Recognizing the larger social footprint that surgical NGOs seek to have, it is important for them to scale their services in alignment with governments, national health agendas and integrate their work within the scope of NSOAPs.
Operation Smile, a surgical NGO with nearly four decades of experience providing comprehensive cleft care to children around the world, is doing exactly this. Through projects such as the ongoing Global Essential Surgery Project, funded by the UBS Optimus Foundation, Operation Smile has coordinated the assessments of local surgical systems in Nicaragua, Madagascar and Vietnam to design and implement capacity building projects in collaboration with local ministries of health and front-line providers.
The project has trained more than 1,000 health care workers, constructed new operating rooms, implemented safe surgical protocols, trained local biomedical technicians, and engaged local communities to increase health-seeking behaviors specific to surgery.
Early results are promising: both surgical admissions and surgical volume within the project’s partner hospitals have increased by more than 60 per cent since 2018. More patients are seeking care, and hospitals possess an increased ability to meet this new demand.
Importantly, the evidence generated through this project will inform the implementation of WHA resolution 68.15 and NSOAPs in other countries, bridging the gap between policy and practice.
Here is our advice for surgical NGOs as they expand their roles towards universal health coverage:
- Establish equitable and long-term partnerships by equipping local providers with the knowledge and training necessary to sustain local efforts, drive economic progress and decrease dependency – recognizing that sustainable surgical/health system strengthening will take time and implementation does not produce immediate results
- Employ a broadened approach that allows for direct service delivery to patients but emphasizes capacity building for local health care providers
- Expand funding sources by seeking additional avenues of funding. Social impact investors are ready to support sustainable programs that are measurable, repeatable and scalable
- Collaboration with other surgical NGOs is critical and must be performed in a transparent manner. Competition will sequester results; collaboration will achieve them
- Data is vital for establishing evidence needed for scaling up impactful programs and implementing health policies. Improved data tracking processes can be integrated into local and national practices to strengthen information management systems
- Partnering with policy makers is paramount. Universal health coverage cannot be achieved without policy development and implementation
As we approach the one-year mark since the first cases of COVID-19 and reflect on a pandemic that has so drastically changed our daily lives, we must look onward to how we will repair the flawed health systems and social inequalities that this virus has exposed.
Moving forward, surgical NGOs must act as catalysts that provide activism, partnership and leadership to drive fundamental change – change that ensures universal access to safe, timely and effective surgical care for health that lasts – no matter where you live or how much money you have.
The role of tech in public healthcare
Patient backlogs, aging populations, increasing amounts of data, the COVID-19 pandemic and a workforce experiencing burnout are just some of the challenges the world's hospitals are experiencing.
Switching to cloud-based digital systems provided by a third party, like electronic health records (EHR) and e-prescriptions, is an obvious solution. According to Peter Springfield, Cloud Product Manager at Node4, all healthcare providers will need to make this change eventually. "Over time, as legacy technology gets older and the demands placed on it increase, storage systems often can’t keep up" he says. "There comes a point for every healthcare organisation when existing IT simply won’t meet its needs anymore. Instead, healthcare facilities need full, near-instant availability of data to make effective decisions and provide good patient care."
Patient data must be readily accessible when needed, stored in a regulation-compliant environment, while remaining cost effective. But how does a paper-based hospital with an overstretched workforce manage this process, while keeping data safe from cyber attacks? By finding a company that can provide the right solution, and working in partnership with them.
Moving to the cloud
The challenge in healthcare, Springfield says, is that many organisations have siloed pools of data stored in separate repositories. "Often, these systems don’t scale well and don’t have the security protections necessary to meet today’s requirements."
"Cloud-based storage can scale as high as required. The best cloud vendors also assure high availability and good performance. And because organisations pay only for the capacity they use with cloud-based storage, costs can be lower. As a result, the cloud model also allows healthcare organisations to store and access all data associated with a specific patient, procedure or business unit in one place."
Another option is to choose Storage as a Service (STaaS). "This is where a third-party provider owns and manages the storage infrastructure, while the healthcare facility can dictate rules on storage, retention and access, along with service level requirements. This structure means that healthcare facilities can access storage on-demand, paying only for the amount they use, without worrying about buying, managing and maintaining physical devices."
Most healthcare providers are choosing a hybrid model, which allows them to use the cloud for everything except the most sensitive data. "Because security and privacy are critical issues for healthcare organisations, the temptation is to keep everything on-premises" Springfield says. "While that can make sense for especially sensitive workloads and applications because it provides tighter controls, it may not be viable for the longer term, as the amount of data that must be managed and stored continues growing."
Keeping patient data secure is not just crucial for the patients, but for the healthcare provider too. Ransomware attacks - where a hacker demands money in exchange for not releasing private data - have risen dramatically in recent years, particularly since the COVID-19 pandemic began. In 2020 alone these rose by 55%, costing almost $21 billion in downtime.
Healthcare providers' inhouse IT departments may not have the knowledge or the resources needed to combat sophisticated attacks, making it necessary to partner with trusted cybersecurity companies.
"Healthcare organisations are moving away from doing everything themselves and doing a lot of outsourcing in the cloud" says Terry Ray, Senior Vice President at cybersecurity firm Imperva. "They may have been running Cerner as their electronic medical record system for 15 years for example, but many are now shifting to say, "why am I running Cerner? Why don't I just pay Cerner to run Cerner? They can enter their data into Cerner's EMR and let it be their problem."
"The field is getting larger and larger, and the enterprise and scope of what needs to be secured is getting bigger" he adds. "You can't have gaps in security. Organisations must look at everything."
While security and data storage are two typical areas where public healthcare providers lean on the tech sector, another has been emerging since the pandemic: telehealth. As well as providing access to doctor appointments during the successive lockdowns caused by COVID-19, telemedicine can help deliver healthcare to remote or rural locations that lack health facilities.
Virtual care solutions are wide-ranging, from Vodafone supplying the connectivity for IoT devices that help elderly people living on remote Greek islands to monitor their diabetes, to TytoCare's portable device that enables doctors to travel to remote regions and examine the heart, lungs, throat, and body temperature of patients using artificial intelligence.
Busy doctors' surgeries are using digital platforms to help them triage patients - such as eConsult, a digital platform used by the British National Health Service (NHS) in primary and emergency care to assess which patients need to urgently speak to a clinician.
As with all tech solutions, security and data privacy are vital. "The potential for technology to improve healthcare is almost limitless" Springfield says "The key is remembering where it starts and ends - with data."
- This article appears in the August issue of Healthcare