The Amsterdam Declaration on Essential Surgical Care

World J Surg DOI 10.1007/s00268-015-3057-x EDITORIAL PERSPECTIVE The Amsterdam Declaration on Essential Surgical Care Matthijs Botman1 • Rinse J. Meester1 • Roeland Voorhoeve1 • Henning Mothes2 • Jaymie A. Henry3 • Michael H. Cotton3 • Robert H. S. Lane4 • Pankaj G. Jani5 • Hugo A. Heij1 • Edna Adan Ismail6  Société Internationale de Chirurgie 2015 Introduction On behalf of the supporting organisations and all participants of the international symposium ‘Surgery in Low Resource Settings’, November 2014, in Amsterdam, we present the ‘Amsterdam Declaration on Essential Surgical Care’. The situation with regard to a lack of surgical capacity in LMICs is untenable, and urgent action is required to alleviate the situation. Many thousands of patients are dying unnecessarily every day because there is no one trained to operate on them. As a consequence, the death toll of surgical conditions in low resource settings currently outnumbers the death toll of HIV, malaria and TB combined. Rarely has there been such unanimity in the field of global surgery, and there is urgent action needed. The lack of surgical care will be on the agenda during the World Health Assembly in May 2015. We solicit international health policy makers to support the initiative towards a WHA resolution on ‘Strengthening Emergency and Essential Surgical Care and Anaesthesia as a component of Universal Health Coverage’. We need to make the world realize that we completely forgot something: Surgery should be part of the United Na- Matthijs Botman and Rinse Meester contributed equally to this work. & Matthijs Botman [email protected] 1 Netherlands Society for International Surgery, Amsterdam, The Netherlands 2 German Society for Tropical Surgery, Homburg, Germany 3 International Collaboration for Essential Surgery, New York, USA 4 International Federation of Surgical Colleges, London, UK 5 COSECSA, Nairobi, Kenya 6 Lancet Commission on Global Surgery, Bellagio, Italy 123 World J Surg tions’ post-2015 sustainable development goals as an essential and named component of universal health coverage. • • The Amsterdam Declaration on Essential Surgical Care • Being concerned about the fact that: • • Two billion people have no access to essential surgical care1 especially in low- and middle-income countries 1 Definition: We define essential surgical care as ‘Basic surgical procedures that save lives and prevent permanent disability or life-threatening complications. Such surgery should be of appropriate quality and safety, accessible at all times and affordable to the community’ Proposed list of 15 essential surgical conditions • • • • Conditions Interventions Obstructed labour Caesarean section. Symphysiotomy, assisted or manipulative delivery Severe uterine bleeding Evacuation of retained products of the Placenta, B-lynch suture, repair of uterine perforation Surgical infections Incision and drainage of abscess, fasciotomy, dental extraction, tympanotomy, bone drilling, arthrotomy Severe wounds (including burns) Severe head injury Airway obstruction Debridement, hemostasis, suturing, escharotomy, skin grafting Management of head injury, cranial burr holes, elevation of depressed skull fracture Management of compromised airway, tracheostomy, cricothyroidotomy, removal of foreign body Chest injury and infections Intercostal drainage, thoracostomy Acute Abdomen Emergency laparotomy including appendicectomy Fractures and Dislocations Reduction of fractures and dislocations, casting and splinting, external fixation Severe limb ischemia, sepsis and injury Amputations Urinary outflow obstruction Suprapubic catheterization Hernia Hernia repair Cataract Cataract extraction and Intraocular lens insertion Clubfoot Casting and splinting, tenotomy Simple cleft lip Cleft lip repair 123 • Five million people die from injuries every year; more than 90 % of whom are found in low-resource settings A third of a million women die every year from childbirth; 15–20 % of whom can be saved through safe essential surgical care Two million women live with untreated obstetric fistula; all entirely in low-resource settings Twenty million people suffer from treatable blindness caused by cataract Millions of people suffer from correctable congenital deformities such as cleft lip and clubfoot Surgical conditions now kill more people than HIV, TB and Malaria combined Surgical and obstetric conditions approximately account for 11 % of the world’s disability-adjusted life years (DALYs) lost each year There is a critical shortage in surgically and anaesthetically trained health care workers in low- and middle-income countries (for example, 0.5 surgeon per 100.000 people in Sub Saharan Africa) The medical infrastructure, supplies and observed procedures in low- and middle-income countries are insufficient to provide the needed essential surgical care Taking into account that: • • • At present there is limited global effort from a public health perspective to reduce the number of deaths and disabilities in low- and middle-income countries caused by surgical conditions Essential surgical care in low-resource settings is cost effective in DALYs and cost competitive to other preventive health measures Making essential surgical care available in lowresource settings requires a multilevel approach We make the following declaration2: • 2 We solicit the support of the governments of all nations, the UN, the WHO, the World Bank, This Declaration was initiated during the final session of the symposium ‘Surgery in Low Resource Settings’ on November 15th, 2014 in Amsterdam with the following organisations represented: AMREF flying doctors, the Association of Surgeons of Great Britain and Ireland, the College of Surgeons of East, Central and Southern Africa (COSECSA), CAPACARE, Doctors Without Borders (MSF— Holland), Edna Adan University Hospital, Emergency, the German Society for Tropical Surgery (DTC), the G4 Alliance, the International Collaboration for Essential Surgery (ICES), the International Committee of the Red Cross (ICRC), the International Federation for Rural Surgery (IFRS), the International Federation of Surgical Colleges (IFSC), Mercy Ships, the Netherlands Society for International Surgery (NSIS), the Netherlands Society for Plastic Surgery (NVPC), Volonteers OverSeas (VSO) and the World Orthopedic Concern (WOC). World J Surg institutional donors as well as other major donors, nongovernmental organisations, all involved medical and surgical societies, colleges and professional bodies. To ensure that: Essential surgery be made available to all regardless of age, gender, race, ethnic group, geographical location, financial status, and political and religious affiliation through the following actions: 1. 2. Incorporate essential surgical care as part of national health services within universal health coverage (UHC) Realign and increase the allocation of resources to improve essential surgical care delivery 3. 4. 5. 6. 7. Make training accessible to health workers providing essential surgical care Ensure the provision of supplies, equipment, and infrastructure for safe, essential surgical care Develop protocols for ethical surgical practice, assessment, audit and follow-up Optimise collaboration amongst all stakeholders such as professional organisations, institutions, charities and funding agencies to avoid duplication and maximise efforts to promote essential surgical care Support the proposed World Health Assembly resolution ‘Strengthening emergency and essential surgical care and anaesthesia as a component of universal health coverage’ in May 2015 123 World J Surg This declaration is supported by: Praveen Aggarwal Academic College of Emergency Experts in India Kelly McQueen Alliance for Surgery and Anesthesia Presence Robert Riviello Center for Surgery and Public Health, Brigham and Women's Hospital Pankaj Jani College of Surgeons of East, Central and Southern Africa Keith MarƟn ConsorƟum of UniversiƟes for Global Health Mamta Swaroop AssociaƟon for Academic Surgery Dean Jamison Disease Control PrioriƟes 3th EdiƟon Edna Adan Ismail Edna Adan University Hospital John Moorehead AssociaƟon of Surgeons of GB and Ireland Robert Pierik AssociaƟon of Surgeons of the Netherlands 123 Gino Strada Emergency Vivekanand Jha George InsƟtute for Global Health, India World J Surg Henning Mothes German Society for Tropical Surgery Fizan Abdullah Johns Hopkins Global Surgery IniƟaƟve Gradian Health Systems Pauline Philip Lifebox FoundaƟon Michael CoƩon InternaƟonal CollaboraƟon for EssenƟal Surgery Wouter Bakker Medical Doctors in InternaƟonal Health and Tropical Medicine Netherlands (TROIE) Peter Reemst InternaƟonal FederaƟon for Rural Surgery Peter Linz Mercy Ships Robert Lane InternaƟonal FederaƟon of Surgical Colleges Henk Koot Netherlands Orthopedic AssociaƟon Jelle Stekelenburg InternaƟonal Safe Motherhood and ReproducƟve Health Ankie van den Broek Netherlands Society for InternaƟonal Health and Tropical Medicine (NVTG) Harshad Sanghvi Jhpiego CorporaƟon Roeland Voorhoeve Netherlands Society for InternaƟonal Surgery 123 World J Surg Henri Winters Netherlands Society for PlasƟc Surgery Shivani Garg Patel Samahope Erin SƟeber SmileTrain Ruben Ayala OperaƟon Smile Susan Koshy Pan-African Academy of ChrisƟan Surgeons Sara Anderson ReSurge InternaƟonal Johan Diedericks South African Society of Anaesthesiologists Miliard Derbew Surgical Society of Ethiopia Hugo Heij Symposium Surgery in Low Resource Seƫngs Jaymie Henry The Right to Heal Declan Magee Royal College of Surgeons in Ireland John McGrath Urolink, BriƟsh AssociaƟon of Urological Surgeons Rosemaru Mukunzi Rwanda Society of Anaesthesiologists Joris Eekhout Voluntary Service Overseas Emile Rwamasirabo Rwanda Surgical Society World FederaƟon of SocieƟes of Anaesthesiologists Roger Eltringham Safe Anaesthesia Worldwide 123 Antoon Schlosser and Michael Laurence World Orthopedic Concern