regulatory bodies, cooperating partners, the private
sector, and the general public. The plan was developed
using an important framework covering the following
domains required for surgical care: infrastructure, service delivery, workforce, financing, and information
management. These domains are codependent and can
only be effective with corresponding developments in
Although the plan has been developed and its costs
determined, this process is only an initial step toward
adding surgery and anesthesia to Zambian national
health care policy. Furthermore, although it is the
first policy of its kind globally, we are still discovering
what lessons can be learned from Zambia’s experience in development and implementation (see Table
1, page 34). The implementation of this plan can only
be accomplished with proper monitoring and evaluation processes in place. However, the commitment of
the Zambian Ministry of Health to this plan ensures
continued progress toward the availability of safe and
affordable surgical, obstetric, and anesthesia services
for all Zambians. ♦
1. Farmer PE, Kim JY. Surgery and global health: A view
from beyond the OR. World J Surg. 2008; 32( 4):533-536.
2. Meara JG, Leather AJ, Hagander L, et al. Global
surgery 2030: Evidence and solutions for achieving
health, welfare, and economic development. The Lancet.
3. Mock CN, Donkor P, Gawande A, et al. Essential
surgery: Key messages from Disease Control Priorities,
3rd edition. The Lancet. 2015;385(9983):2209-2219.
4. Organization WHA Resolution 68. 15—Strengthening
Emergency and Essential Surgical Care and Anaesthesia
as a Component of Universal Health Coverage. 2015.
Available at: apps.who.int/gb/ebwha/pdf_files/WHA68/
A68_R15-en.pdf. Accessed April 21, 2017.
5. Central Intelligence Agency. Zambia. The World
Factbook 2016. Available at: www.cia.gov/library/
Accessed April 18, 2017.
6. Esquivel MM, Uribe-Leitz T, Makasa E, et al.
Mapping disparities in access to safe, timely, and
essential surgical care in Zambia. JAMA Surg.
Panel at the Zambian NSOAF
Costing workshop facilitated by the Zambian Ministry of Health and the Program in Global Surgery and Social Change team