Africa has witnessed a tipping point in global surgery, anaesthesia and obstetric care. On February 1, 2017, His Excellency Dr Mustapha Kaloko, the Commissioner of Social Affairs for the African Union, gave his opening address to the Pan African Association of Surgeons in the African Union Commission Conference Center, Addis Ababa, Ethiopia. It was an address that would have been inconceivable just 2 years ago. For one reason, he commented on the findings of The Lancet Commission on Global Surgery, which had not yet been published. He recognised the pivotal, "indispensable" role of surgery in health-care delivery, and at the same time addressed the parallel imperative of providing financial risk protection for the poor. Most importantly, Commissioner Kaloko implored Africans to put "global surgery on the political and policy agenda of our governments": a clear and unmistakable call to action for all stakeholders. With this speech, Africa has thus added another voice to regions all over the world calling for better investment in surgical services. In less than 2 years, the global surgery narrative has gone from discussions of neglect, burden, and despair, to those of strategy, hope, and collaboration. This is encouraging to say the least; however, we can not rest yet. The positive rhetoric urgently needs to be translated into action to ensure delivery of universal access to safe, affordable surgical and anaesthesia care when needed. We present Dr Kaloko's speech in full below.
"Excellences, Ladies and Gentlemen, Let me take this opportunity to welcome you all to this 2017 International Conference on Global Surgery. It gives me great pleasure to see African surgeons and anaesthetists taking leadership and setting the policy and political agenda for universal access to global surgery. Over the past two decades, significant strides have been made in global health leading to remarkable reductions in death and disability. However, significant challenges remain that includes inadequate investments in health systems, integration of services, and hospital-based care. It is also equally important that we move towards ensuring that global surgery is prioritised in our health systems. Universal access to surgery is an indispensable part of a functional health system. Recently The Lancet Commission on Global Surgery highlighted the astounding challenges ahead of us: • 5 billion people lack access to safe affordable surgical services when needed • N ine out of ten people in developing countries cannot access basic surgical care • 1 43 million additional surgical procedures are needed each year to save lives and prevent disability • O nly 6% of 313 million procedures that are undertaken
worldwide annually, are performed in the poorest countries • 3 3 million individuals face catastrophic health expenditure to pay for surgical services In most of our countries access to safe and affordable surgical care remains out of reach for over 90% of the population. This results in loss of life and reduced welfare for millions of people, and affects the trajectory towards economic development. Our long-term development vision, Agenda 2063, cannot be achieved if the health of our human capital cannot be assured. It is therefore imperative that our national governments begin to work on developing national health strategic frameworks that specifically address surgical care within the broader strategy for national health systems improvement. National surgical plans will play an essential role for the proper planning and delivery of services, training and research. The use of surgical services can be impoverishing for households in the absence of effective financial risk protection measures. In order to improve access to surgical care and reduce the burden on households we must commit to the introduction of health financing mechanisms that safeguard people from catastrophic health expenditure. This requires expanding the fiscal space for health through moving away from direct health financing mechanisms that rely on out-of-pocket expenditure. We should work to expand the fiscal space for health through indirect financing mechanisms such as general taxation and health insurance schemes. The Africa Health Strategy (2016–2030) which is aligned to Agenda 2063 and Agenda 2030 provides a clear strategic direction to African Union Member States in their efforts to create better performing health sectors. As the primary consolidative document for all African commitments in the health sector, the added value of the strategy is its ability to inspire, guide and highlight strategic directions relevant to all Member States. It advocates for and promotes Member State action to prioritise and invest in social determinants of health through better inter-sectoral collaboration, highlights the central importance of health systems strengthening priorities and health financing, calls for better leveraging of community strengths and publicprivate partnerships, and recommends a paradigm shift that helps Member States more effectively manage the risks of disasters in a more systematic manner. Let me end by reiterating the fundamental importance of putting global surgery on the political and policy agenda of our governments. There is a clear investment case for surgical and anaesthetic services, they save lives, can be affordable and contribute to economic growth and the achievement of Agenda 2063 aspirations. More importantly, surgery is an indispensible part of health care and should be an integral component of a national health system in countries at all levels of development. Surgical care plays a fundamental role in averting death and disability from injuries, maternal conditions such as obstructed labour, neonatal conditions such as cleft palate, and noncommunicable diseases such as breast and cervical cancer. Governments must therefore ensure that health policies and services targeted to the prevention of maternal and child deaths, non-communicable diseases and injuries specifically make provision for surgical services in order for these policies to be effective. I thank you for your attention."
