A very good morning to all; it is a pleasure to join you for the launch of this timely webinar series on coordinating surgical system strengthening across Asia-Pacific.
The universal provision of an essential surgical services package could prevent 6–7% of all avertable deaths in low- and middle-income countries globally, including in Asia-Pacific.
And yet according to the Lancet Commission on Global Surgery, in 2015 an estimated 5 billion people globally lacked access to safe, affordable and timely surgical and anaesthesia care.
The poorest third of all people globally received just 3.5% of all operations and developing countries had the lowest number of surgeons per head of population.
Today, an estimated 143 million surgical procedures are required across the world each year to save lives and prevent disability.
The WHO South-East Asia Region has in recent years integrated surgical system strengthening into its overall quest to achieve universal health coverage (UHC), which is one of eight Flagship Priorities, one of three “triple billion” targets, and at the heart of Sustainable Development Goal 3.
The Region continues to draw on global momentum to enhance surgical system strengthening, reflected in WHA68.15 and WHA72.16, and continues to implement key technical guidance using facility and country-level data to drive health policy.
Over the past two decades, the Region has made world-beating progress in reducing maternal mortality, which is of course a strong proxy indicator for equitable access to basic and comprehensive emergency obstetric care, which around 15% of all pregnant women require.
Between 2000 and 2017, the Region achieved a 57% reduction in maternal deaths, compared with 38.4% globally.
Accelerating reductions in maternal, child and under-five mortality continues to be a Flagship Priority, for which the Region’s Technical Advisory Group on Women’s and Children’s Health is providing actionable guidance to each of the Region’s 11 Member States.
The Region is more than halfway through its Decade for Health Workforce Strengthening and has made substantial progress in enhancing health workforce density and skills, which is vital to the provision of safe and effective surgical, obstetric, anaesthesia and trauma care.
By 2030, the Region aims to reach a surgical, anaesthetic and obstetric provider density of at least 0.2 per 1000 population, which I am certain we can achieve.
Commendably, all countries continue to implement national blood policies that are aligned with the global WHO Strategic Framework for Blood Safety and Availability and continue to screen 100% of all donated blood for transfusion transmitted infections.
Moving ahead, we do indeed face many challenges, but perhaps the most significant of all are the fiscal challenges that will result from the COVID-19 pandemic, as well as expected declines in household incomes.
Combined, these could result in a considerable increase in foregone care as well as in out-of-pocket payments (OOPs).
This is why WHO is urging all countries in the Region to not only sustain but scale up public health spending as a percentage of GDP, and to also increase financial protection so that access to essential services, including surgical care, can be maintained and enhanced throughout the COVID-19 response, recovery and beyond.
Thailand and Indonesia in particular have demonstrated how increases in pre-payment and public financing can deliver sustained reductions in OOPs, while India has extended financial protection to upwards of 500 million people for secondary and tertiary in-patient care packages.
WHO will continue to support all countries to increase the volume and efficiency of public health spending, including on surgical system strengthening, to achieve maximum impact.
Beyond health financing, several priorities must guide the Region’s onward mission to ensure essential surgical services are accessible to all.
First, planning must be conducted on a multi-year basis and consider the entire health sector – including the private sector – as well as other sectors that contribute to health.
The adoption of detailed and fully costed sector-wide approaches will facilitate the development of comprehensive, feasible and sustainable strategic planning, which all countries will benefit from.
Second, planning for the provision of specific services must be aligned with and integrated into each country’s overarching multi-year health plan.
Doing so will avoid verticalization and ensure that surgical system strengthening plans are supported with adequate human resources, medicines, equipment and infrastructure, as well as strong supply chains and utilities for sterilization, maintenance and waste disposal.
Third, referral systems must be strengthened to enhance efficiency and ensure that optimal care is available at the appropriate level and that resources are used in a cost-effective manner.
And fourth, the implementation of monitoring and evaluation systems – including of service quality and patient safety – must be prioritized to ensure that all adverse events are detected and followed up on.
Specific efforts are needed to monitor and avoid unnecessary caesarean sections and lapses in infection prevention and control.
Ensuring that health services are of adequate quality is a core component of UHC and must be central to our shared effort to strengthen surgical systems in the South-East Asia Region and across Asia-Pacific.
I wish you all the very best in the coming webinar series and look forward to building momentum in this crucial area of work.
Thank you.