The Current Global Surgical Care Paradigm: An Introduction

  • Sujata K. BhatiaEmail author
  • Krish W. Ramadurai
Part of the SpringerBriefs in Materials book series (BRIEFSMATERIALS)


Approximately 5 billion people around the world do not have access to safe, affordable surgical services when needed (Meara et al. in The Lancet, 386(9993):569–624, 2015). In further exploring the nature of this startling figure, an interesting trend becomes further apparent. Inequities related to access to surgical services becomes stratified based upon relative income distribution of countries. Simply stated, accessibility to surgical services varies in each country based upon their respective income classification. The World Bank classifies countries according to four income groupings, in which income is measured using gross national income (GNI) per capita, in U.S. dollars (Debas et al. in Disease control priorities, (Volume 1): Essential surgery. World Bank Publications, 2015). These four classifications are as follows: low-income countries (LICs) = $1045 or less, Middle-income countries (MICs) which are subdivided into lower-middle-income = $1046 to $4125 and upper-middle-income (UMICs) = $4126 to $12,745, and finally high-income countries (HICs) = $12,746 or more as shown in Fig. 1.1 (Debas et al. in Disease control priorities, (Volume 1): Essential surgery. World Bank Publications, 2015). Upon examination of these income classifications, stratification in accessibility to surgical services becomes evident, with the countries having the lowest gradients in accessibility to surgical services being that of low and middle-income countries (LMICs).


  1. Alkire, B. C., Raykar, N. P., Shrime, M. G., Weiser, T. G., Bickler, S. W., Rose, J. A., … & Esquivel, M. (2015). Global access to surgical care: A modeling study. The Lancet Global Health, 3(6), e316–e323.Google Scholar
  2. Alwan, A., MacLean, D. R., Riley, L. M., d’Espaignet, E. T., Mathers, C. D., Stevens, G. A., et al. (2010). Monitoring and surveillance of chronic non-communicable diseases: Progress and capacity in high-burden countries. The Lancet, 376(9755), 1861–1868.CrossRefGoogle Scholar
  3. Bickler, S. W. (2013, January 16). Global Burden of Surgical Disease. Lecture presented at The Lancet Commission on Global Surgery in Boston, Massachusetts.Google Scholar
  4. Chao, T. E., Sharma, K., Mandigo, M., Hagander, L., Resch, S. C., Weiser, T. G., et al. (2014). Cost-effectiveness of surgery and its policy implications for global health: A systematic review and analysis. The Lancet Global Health, 2(6), e334–e345.CrossRefGoogle Scholar
  5. Cotton, M. (2016). Primary Surgery Volume One: Non-Trauma (2nd ed., Vol. 1). Oxford University Press.Google Scholar
  6. Country Income Groups (World Bank Classification) (2011). Country and Lending Groups, The World Bank Group. Retrieved September 17, 2016, from
  7. Dare, A. J. (2015). Lancet Commission on Global Surgery Economics & Financing. Retrieved December 02, 2016, from
  8. Debas, H. T., Donkor, P., Gawande, A., Jamison, D. T., Kruk, M. E., & Mock, C. N. (Eds.). (2015). Disease control priorities, (Volume 1): Essential surgery. World Bank Publications.Google Scholar
  9. Diaconu, K., Chen, Y. F., Manaseki-Holland, S., Cummins, C., & Lilford, R. (2014). Medical device procurement in low-and middle-income settings: Protocol for a systematic review. Systematic Reviews, 3(1), 118.CrossRefGoogle Scholar
  10. Elkheir, N., Sharma, A., Cherian, M., Saleh, O. A., Everard, M., Popal, G. R., et al. (2014). A cross-sectional survey of essential surgical capacity in Somalia. British Medical Journal Open, 4(5), e004360.Google Scholar
  11. Farmer, P. E., & Kim, J. Y. (2008). Surgery and global health: A view from beyond the OR. World Journal of Surgery, 32(4), 533–536.CrossRefGoogle Scholar
  12. Frilling, A. (2016). Role of surgeons in the changing sociocultural, political, and environmental climate. Annals of Surgery, 264(5), 691–695.CrossRefGoogle Scholar
  13. Funk, L. M., Weiser, T. G., Berry, W. R., Lipsitz, S. R., Merry, A. F., Enright, A. C., … & Gawande, A. A. (2010). Global operating theatre distribution and pulse oximetry supply: An estimation from reported data. The Lancet, 376(9746), 1055–1061.Google Scholar
  14. Gunn, S. W. A. (2012). Dictionary of disaster medicine and humanitarian relief. Springer Science & Business Media.Google Scholar
  15. Higashi, H., Barendregt, J. J., Kassebaum, N. J., Weiser, T. G., Bickler, S. W., & Vos, T. (2015). Burden of injuries avertable by a basic surgical package in low-and middle-income regions: A systematic analysis from the Global Burden of Disease 2010 Study. World Journal of Surgery, 39(1), 1–9.CrossRefGoogle Scholar
  16. Hostettler, S. (2015). Technologies for development. Berlin: Springer.Google Scholar
  17. Ibrahim, A. M., Jose, R. R., Rabie, A. N., Gerstle, T. L., Lee, B. T., & Lin, S. J. (2015). Three-dimensional printing in developing countries. Plastic and Reconstructive Surgery Global Open, 3(7), 1–5.Google Scholar
  18. Jamison, D. T., Breman, J. G., Measham, A. R., Alleyne, G., Claeson, M., Evans, D. B., … & Musgrove, P. (Eds.). (2006). Disease control priorities in developing countries. World Bank Publications.Google Scholar
  19. King, M., Bewes, P., Cairns, J., & Thornton, J. (1990). Primary surgery. Vol. 1. Non-trauma. Oxford Medical Publications.Google Scholar
  20. Kushner, A. L., Cherian, M. N., Noel, L., Spiegel, D. A., Groth, S., & Etienne, C. (2010). Addressing the millennium development goals from a surgical perspective: Essential surgery and anesthesia in 8 low-and middle-income countries. Archives of Surgery, 145(2), 154–159.CrossRefGoogle Scholar
  21. Meara, J. G., Leather, A. J., Hagander, L., Alkire, B. C., Alonso, N., Ameh, E. A., … & Mérisier, E. D. (2015). Global surgery 2030: Evidence and solutions for achieving health, welfare, and economic development. The Lancet, 386(9993), 569–624.Google Scholar
  22. Mock, C. N., Donkor, P., Gawande, A., Jamison, D. T., Kruk, M. E., & Debas, H. T. (2015). Essential surgery: Key messages from disease control priorities. The Lancet, 385(9983), 2209–2219.CrossRefGoogle Scholar
  23. Ozgediz, D., & Riviello, R. (2008). The “other” neglected diseases in global public health: Surgical conditions in sub-Saharan Africa. PLoS Med, 5(6), e121.CrossRefGoogle Scholar
  24. Rankin, T. M., Giovinco, N. A., Cucher, D. J., Watts, G., Hurwitz, B., & Armstrong, D. G. (2014). Three-dimensional printing surgical instruments: Are we there yet? Journal of Surgical Research, 189(2), 193–197.CrossRefGoogle Scholar
  25. Rose, J., Weiser, T. G., Hider, P., Wilson, L., Gruen, R. L., & Bickler, S. W. (2015). Estimated need for surgery worldwide based on prevalence of diseases: A modeling strategy for the WHO Global Health Estimate. The Lancet Global Health, 3, S13–S20.CrossRefGoogle Scholar
  26. Smith, D., Maru, R., McGee, H. M., Brady, J. S., King, C. A., Andrews, J., … & Adam, C. (2013). Global surgical care in 2030: Metrics and strategies for expansion in access and quality, 1–6.Google Scholar
  27. Su, T. T., Kouyaté, B., & Flessa, S. (2006). Catastrophic household expenditure for health care in a low-income society: A study from Nouna District, Burkina Faso. Bulletin of the World Health Organization, 84(1), 21–27.CrossRefGoogle Scholar
  28. UN, A. (2013). New Global Partnership: Eradicate poverty and transform economies through sustainable development: The report of the high-level panel of eminent persons on the post-2015 development agenda. United Nations, New York.Google Scholar
  29. Wang, H., Naghavi, M., Allen, C., Barber, R. M., Bhutta, Z. A., Carter, A., … & Coggeshall, M. (2016). Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: A systematic analysis for the global Burden of disease study 2015. The Lancet, 388(10053), 1459–1544.Google Scholar
  30. Weiser, T. G., Regenbogen, S. E., Thompson, K. D., Haynes, A. B., Lipsitz, S. R., Berry, W. R., et al. (2008). An estimation of the global volume of surgery: A modeling strategy based on available data. The Lancet, 372(9633), 139–144.CrossRefGoogle Scholar
  31. Xu, K., Evans, D. B., Carrin, G., & Aguilar-Rivera, A. M. (2005). Designing health financing systems to reduce catastrophic health expenditure. Technical Briefs for Policy-Makers, (2), 1–5.Google Scholar
  32. World Health Organization. (2010). Medical devices: Managing the mismatch: an outcome of the priority medical devices project. World Health Organization.Google Scholar
  33. World Health Organization. (2014). Strengthening emergency and essential surgical care and anesthesia as a component of universal health coverage.Google Scholar

Copyright information

© The Author(s) 2017

Authors and Affiliations

  1. 1.John F. Kennedy School of GovernmentHarvard UniversityCambridgeUSA
  2. 2.Chemical and Biomolecular EngineeringUniversity of DelawareNewarkUSA
  3. 3.John F. Kennedy School of Government, Faculty of Arts and SciencesHarvard UniversityCambridgeUSA

Personalised recommendations