The Republic of Zambia is a LMIC located in Southern Africa with a population of 15 million people.
estimated 74 percent of Zambians do not have access to
timely, safe, and affordable surgical care.
6 After championing the effort at the WHA to prioritize emergency
and essential services, Zambia has taken efforts to
strengthen the surgical system from paper to policy
by embarking on a process to create a NSOASP.
One of the priorities of the NSOASP was to integrate
this plan within Zambia’s overall National Health Strategic Plan (NHSP), which was set to renew beginning
in 2017 through 2021. Creating a NSOASP as a component of a country’s NHSP was an unprecedented
process, requiring innovation, initiative, and strong
support from a range of stakeholders, especially the
central leadership role of the Ministry of Health. In
Zambia, this process included the phases shown in
Figure 1 (this page).
Analyzing baseline indicators
The LCoGS recommended the measurement of six
key indicators necessary to assess a country’s surgical system. These indicators of a surgical system are
• Two-hour access to a facility offering surgical services
•Surgical workforce density
•Perioperative mortality rate
•Protection against impoverishing expenditure
•Protection against catastrophic expenditure
The data pertinent to these six indicators are pub-
licly available through the Zambia Health Management
Information System (HMIS) and through the Institute
for Health Metrics and Evaluation (IHME). These
data initially indicated that 76 percent of the Zambian
population have access to surgical services; however,
subsequent validation showed that 74 percent of Zam-
bians do not have access to timely, safe, and affordable
surgical and anesthesia care.
6 Furthermore, the Zam-
bian surgical workforce density was 0.79 providers per
100,000 population, far below the density of 20 provid-
ers per 100,000 that the LCoGS recommends.
Surgical volume is estimated at 1,617 cases per
100,000 population, as compared with the recommended 5,000 per 100,000 population.
mortality, the most basic measure of surgical outcomes,
was difficult to reliably assess using the available data.
However, issues of financial risk protection were calculated, which indicated that 56 percent of the population
risk catastrophic expenditure from surgery, with a
94 percent chance of impoverishment from procedures
such as cesarean delivery.
FIGURE 1. NSOASP PROCESS IN ZAMBIA
V102 No 6 BULLETIN American College of Surgeons