In the April issue of the Bulletin, “Using global sur- gical indicators to improve trauma care in Latin America” introduced readers to the relationship
between The Lancet Commission on Global Surgery’s (LCoGS) core surgical indicators and specific
components of trauma program and systems development in Latin America.
1 An article in the July issue
of this publication centered on prehospital care using
a trauma systems application of LCoGS indicator 1
(LCoGS I- 1).
2 This month, the authors explore the
link between LCoGS indicator 2 (LCoGS I- 2), workforce and acute care surgery education and training,
as well as acute care surgery’s role in responding to
World Health Assembly (WHA) Resolution 68. 15.
Global preparedness for
surgical care delivery
Access to surgical care is paramount to improving health care systems in resource-poor settings.
Mounting evidence highlights the health, economic,
and welfare inequities that result from inadequate
access to surgical care. The LCoGS created indicators
to track progress toward surgical care equity and universal access to surgery, and those indicators fall into
three categories: preparedness, delivery, and impact
(see Table 1, page 28).
At the 2015 68th WHA—the meeting during which
Emergent and essential surgery
the World Health Organization (WHO) established its
top health policy priorities—strengthening emergency
and essential surgical care was highlighted as a criti-
cally important component of universal health coverage
through the passage of WHA Resolution 68. 15.
resolution urged both member states and national-level
leadership to prioritize emergency and essential sur-
gery services by enacting significant improvements
to the provision, access, monitoring, and policies
regarding surgical care (see Table 2, page 29). With
the increased role of global surgery in public health, the
challenge will now be to accurately characterize the
surgical capability—or capacity—of individual regions
to provide universal coverage. One of the first steps
toward addressing the capacity limitations in Latin
America is to provide access to education and train-
ing opportunities that augment the surgical workforce.
The LCoGS attempted to address the capacity issue
first by suggesting a framework to strengthen national
surgical systems. Its recommendations resulted in the
six indicators in the aforementioned three categories.
The first two indicators are in the preparedness cat-
egory: LCoGS I- 1, timely access to care, and LCoGS I- 2,
the workforce density of surgery, anesthesia, and obstet-
rics (SAO) providers per 100,000 national population.
The discussion that follows focuses on strengthening
Latin America’s emergent and essential surgical work-
force. To accomplish this, the proposed strategy is to
expand the role of acute care surgery—an evolving spe-
cialty that includes three essential components: trauma,
critical care, and emergency surgical care. We show that
the workforce can be buttressed through an empha-
sis on education and training to scale up sustainable
infrastructure with respect to preparedness LCoGS I- 2
workforce in Latin America
LCoGS I- 2 is the most intuitive indicator—that is,
national surgical capacity is reliant on the number of
providers with operative and anesthetic capabilities.
The LCoGS recommends that low- and middle-income
countries (LMICs) set a target of 20 to 40 SAO providers per 100,000 people. The combined efforts of the
LCoGS and the WHO have led to an assessment of SAO
workforce density in 31 Latin American and Caribbean
countries (176 countries total).
5 The surgical workforce
is commonly assessed via national data banks that document registered SAOs and/or extrapolation from survey
studies. These methods include a mixture of subjective and objective sources, such as health care facility
capacity surveys (for example, personnel, infrastructure, procedures, equipment, and supplies [PIPES]),
SEP 2017 BULLETIN American College of Surgeons
SURGICAL WORKFORCE IN LATIN AMERICA