In 1978, the Alma-Ata Declaration was adopted at the international conference on primary health care, held in Alma-Ata (Almaty), Kazakhstan. It identified primary health care as the key to the attainment of the goal of Health for All. It expressed the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all people. Since then, primary health care has never left the policy agenda.
From ‘health for all’ to ‘surgery for all’…
In 2014, the Amsterdam Declaration on essential surgical care was adopted at the international symposium ‘Surgery in low resource settings’, held in Amsterdam, the Netherlands. Many international organisations attended the symposium, amongst them: AMREF flying doctors, CAPACARE, Doctors Without Borders (MSF – Holland), the G4 Alliance, the International Committee of the Red Cross (ICRC), and colleges of surgeons from different countries.
Key message: two billion people have no access to essential surgical care, especially in low- and middle-income countries. The death toll of surgical conditions outnumbers the death toll of HIV, malaria and TB combined.1 Basic surgical procedures can save lives and prevent disability, such surgery should be safe and accessible. Many essential surgical interventions are cost-effective, e.g. cost-effectiveness ratio for vaccinations is $25 per DALY, general surgery $82 per DALY, HIV-treatment $453 per DALY.2 A proposed list of 15 essential surgical conditions can be read in the Declaration.
The Amsterdam Declaration was published in the World Journal of Surgery.3
The surgical need was on the agenda during the World Health Assembly in 2015, and resolution WHA68.15 ‘Strengthening emergency and essential surgical care and anesthesia as a component of universal health coverage’ was adopted.4 The WHA urges member states to prioritize emergency and essential surgery and anaesthesia services, and to integrate this in primary health care facilities and first-referral hospitals. The resolution outlines the highest level of political commitment.
In 2016 the United Nations defined the Sustainable Development Goals (SDG). SDG 3 concerns health, but surgery is still insufficiently addressed. “Goal 3 seeks to ensure health and well-being for all, at every stage of life. The Goal addresses all major health priorities, including reproductive, maternal and child health; communicable, non-communicable and environmental diseases; universal health coverage; and access for all to safe, effective, quality and affordable medicines and vaccines.” Amongst the targets are:
By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births.
By 2020, halve the number of global deaths and injuries from road traffic accidents.
Advocacy is still needed for ‘access to safe and affordable surgery and anaesthesia’, instead of only ‘medicines and vaccines’.
Therefore, the Amsterdam Declaration states:
We solicit the support of the governments of all nations, the UN, the WHO, the World Bank, institutional donors as well as other major donors, non-governmental 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.
- Global access to surgical care: a modelling study. Blake C Alkire, Lancet Glob Health 2015; 3: e316–23 http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(15)70115-4/abstract
- Cost-effectiveness of surgery and its policy implications for global health, T. Chao et al. Lancet Glob Health 2014; 2: e334–45 http://www.thelancet.com/pdfs/journals/langlo/PIIS2214-109X(14)70213-X.pdf
- Botman, M., Meester, R.J., Voorhoeve, R. et al. World J Surg. 2015;39:1335-40
- WHA68.15 resolution http://apps.who.int/gb/ebwha/pdf_files/WHA68/A68_R15-en.pdf
Link to the declaration:
Link to the publication in the World Journal of Surgery: