1. 1 |1 | Emergency and Essential Surgical Care Programme 2016 WHA 68.15: background, genesis, mandates, implementation Walt Johnson, MD, MBA, MPH, FACS Emergency and Essential Surgical Care Programme 2016 WHA 68.15: background, genesis, mandates, implementation Walt Johnson, MD, MBA, MPH, FACS 24 March, 2016

2. 2 |2 | Origins of Surgery at WHO Director General Halfdan Mahler (1973-1988): “Social injustice is socially unjust in any field of endeavour, and the world will not tolerate it much longer. So the distribution of surgical resources in countries and throughout the world must come under scrutiny in the same way as any other intellectual, scientific, technical, social or economic commodity. The era of only the best for the few and nothing for the many is drawing to a close.” Surgery and Health for All XXII BIENNIAL WORLD CONGRESS OF THE INTERNATIONAL COLLEGE OF SURGEONS Mexico City, Sunday 29 June, 1980 24 March, 2016 Phnom Penh Conference

3. 3 |3 | Hiatus Surgery eclipsed by Vaccine Programmes and HIV/AIDS 24 March, 2016 Phnom Penh Conference Ali Maow Maalin, the last case of smallpox in Somalia, 1978

4. 4 |4 | Surgery as Cost-Effective Public Health 24 March, 2016 Phnom Penh Conference

5. 5 |5 | Comparative Cost-Effectiveness InterventionCost-Effectiveness Rapid-impact package for NTD US$2-$9 per DALY averted Measles vaccinationUS$5 per DALY averted Basic surgical servicesUS$11-$33 per DALY averted ARV therapy for HIV/AIDSUS$300-$500 per DALY averted 24 March, 2016 Phnom Penh Conference Ozgediz D, Riviello R (2008), The “Other” Neglected Diseases in Global Public Health: Surgical Conditions in SSA. PLoS Med 5(6): e121

6. 6 |6 | As Public Health Succeeds, Need for Surgery Increases Due to: Communicable to NCD Diseases of prosperity Aging population 24 March, 2016 Phnom Penh Conference

7. 7 |7 | Surgery at WHO 2004 –Emergency and Essential Surgical Care Programme (EESC) initiated by Dr. Meena Nathan Cherian 2005 –Global Initiative for Emergency and Essential Surgical Care (GIEESC) Global forum for surgeons and those with interest Currently 2150 members from 140 countries Biennial Meetings –Geneva, Tanzania, Mongolia, San Diego, Trinidad 24 March, 2016 Phnom Penh Conference

8. 8 |8 | WHO GIEESC Membership 29 September, 2015 24 March, 2016 Phnom Penh Conference

9. 9 |9 | EESC Surgical Care at the District Hospital 2003 Integrated Management of Emergency and Essential Surgical Care Toolkit 24 March, 2016 Phnom Penh Conference

10. 10 | 24 March, 2016 Phnom Penh Conference (2012)

11. 11 | 24 March, 2016 Phnom Penh Conference

12. 12 | 2015 * * * * * * 24 March, 2016 Phnom Penh Conference * *

13. 13 | WHA Resolution 68.15 24 March, 2016 Phnom Penh Conference

14. 14 | Resolution Building Blocks Unfinished business of MDGs WHA55.18 on quality of care WHA56.24 on strengthening trauma services WHA57.10 to strengthen emergency and rehabilitation services for victims of road- traffic injuries WHA58.23 on disability—15% of world population WHA60.22 on health systems: emergency-care systems WHA64.6 on health workforce strengthening WHA66.10 on the prevention and control of non- communicable diseases WHA67.25 on antimicrobial resistance WHA67.19 on strengthening of palliative care 24 March, 2016 Phnom Penh Conference

15. 15 | Essentials of Resolution Develop a roadmap toward implementation of the resolution: ultimately develop NSCP for each Member State –Advocacy, Finances and other resources development –Care Delivery: Access, integration, infrastructure, systems –Information management: Data collection, analysis, monitoring and evaluation –Essential medicines –Workforce: Training, credentialing, competency, oversight Report on progress by WHA 2017 24 March, 2016 Phnom Penh Conference

16. 16 | 24 March, 2016 Phnom Penh Conference

17. 17 | Roadmap 24 March, 2016Phnom Penh Conference

18. 18 | Timeline 24 March, 2016 Phnom Penh Conference

19. 19 | Partnerships 24 March, 2016 Phnom Penh Conference

20. 20 | Key Recommendations Foster Advocacy –High levels to promote awareness and develop funding –Country level for local funding and MOH to take ownership Improve Access, System Integration Develop Data-Driven Health Policy –Country-level National Surgical Care Plans (including anaesthesia care) that are fully integrated component of National Health Plans Country-led, country-owned –Develop Dashboards for MOH using key indicators Utilize “Core” indicators as a baseline—POMR, Surgical Volume and Surgical “Trained Provider” Density Build using indicators chosen by MOH for optimal value 24 March, 2016 Phnom Penh Conference

21. 21 | G4 Alliance 24 March, 2016 Phnom Penh Conference

22. 22 | Access, Integration, and Systems What determines or prevents access? –What are the barriers –What are the facilitators –What process(es) will open up access? Can you teach integration or must it be legislated? How to promote “twinning” (from either side) How to best develop a “surgical delivery system” –Is it different for countries, regions, cultures? How do you promote UHC in countries that do not support it? 24 March, 2016 Phnom Penh Conference

23. 23 | Figure Global Surgical Workforce (SAO) 24 March, 2016 Phnom Penh Conference

24. 24 | GHO 24 March, 2016Phnom Penh Conference

25. 25 | Building the System Health service delivery Health workforce Health information systems Access to essential medicines Health systems financing Leadership and governance 24 March, 2016 Phnom Penh Conference

26. 26 | POMR Surgical Volume 2h Access SAO Density Impoverishing Expenditure Catastrophic Expenditure WHO 100 Core Health Indicators 2015 24 March, 2016 Phnom Penh Conference

27. 27 | Two Hour Acces s EXAMPLE: MONGOLIA 24 March, 2016 Phnom Penh Conference

28. 28 | Data Dashboards Make data easy to visualize and follow Use data to drive national health policy –Develop national surgical care plans within NHP 24 March, 2016 Phnom Penh Conference

29. 29 | Additional Points Margaret Chan and Jim Kim: Indicators should not be a burden Make data collection a culture Train data collectors as part of system building Make the data inputs flexible to country needs 24 March, 2016Phnom Penh Conference

30. 30 | Key Recommendations Encourage MOH and other government agencies to adopt a balanced approach –limiting illegal use –appropriate availability for proper medical treatment and EESC Develop minimal standards/guidelines for credentialing –Promote education programmes toward surgical skills –Develop task-sharing/shifting curricula –Develop criteria and standards for collecting credentialing data 24 March, 2016 Phnom Penh Conference

31. 31 | WFSA Ketamine: “Ketamine is a Medicine, not a Drug” Campaign Narcotics –Post-op –Palliative care Antibiotics: Wise utilization Advocacy: Children, Adults Safe Anaesthesia Guidelines Training issues 24 March, 2016 Phnom Penh Conference

32. 32 | West African College of Surgeons (WACS) College of Surgeons of East, Central and Southern Africa (COSECSA) Royal Colleges American College of Surgeons Professional Societies MoH, MoE 24 March, 2016 Phnom Penh Conference

33. 33 | Role of WHO in Global Surgery { Stephen W. Bickler David Spiegel - World J Surg (2010) 34:386–390} 24 March, 2016 Phnom Penh Conference

34. 34 | Next Steps Implementation –Pilot Projects –Specialty/Subspecialty projects Bridge building with Partners Advocacy, fund and resource development Continue current work as means of advocacy –Guidelines –Publications –Speaking engagements 24 March, 2016 Phnom Penh Conference

35. 35 | Thank You! 24 March, 2016 Phnom Penh Conference