By Dr. Scott Corlew and Dr. Blake Alkire
We continue this blog looking at financial aspects of delivering surgical care.
Of paramount importance in the examination of expenditure on surgical services as well as overall health care is the quality of data available. Dielman, Yamey, Johnson, Graves, Haakenstad and Meara, Tracking global expenditures on surgery: gaps in knowledge hinder progress (2015) Lancet Glob Health 3 (S2):S2-S4 examined this issue. They found hard data quite sparse, but found that less than 1% of the development assistance for health that passed from HICs to LMICs in 2011 was for the support of surgery. They discuss this issue further, pointing out that expenditure coupled with burden of disease would provide valuable information for planning and projection of needed financing. This can be of further value when the expenditure can be examined by type of surgery, thereby enabling the identification of areas in which efforts toward prevention could be of great value (burn injuries or tobacco-associated disease would be prime examples).
Appropriate tracking of expenditure as part of National Health Accounts would also enable monitoring of funding efforts. Coupling investment in expenditure tracking with health care support would increase the likelihood of that support delivering the value intended. As we move toward implementing measures to address the 2030 goals outlined in the report of the Lancet Commission on Global Surgery, this will be necessary for the scaling up of access to surgical care.
Before money can be spent on surgical services, it must exist for that purpose. Gutnik et al., in Funding flows to global surgery: an analysis of contributions from the USA, Lancet 2015; 385 (Global Surgery special issue): S51, examined the sources of external funding for surgical services in LMICs from the US, which is the largest donor nation. The findings are shown below. Of significant interest is the overwhelming proportion from private charity: almost five times the amount given by more regulated or peer-reviewed sources.
These findings make the point that while decisions, research, and obviously clinical work must be data-driven and fact-based, the fund-raising aspect of providing surgical care is more a function of advocacy efforts. It behooves us to continue to include advocacy in our efforts, and to make sure that integrity is the major component of our advocacy efforts, including focusing those efforts on appropriate unmet surgical needs in the world.