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Essential surgery, including basic interventions, can be provided by non-physician clinicians (NPCs) in low- and middle-income countries. Training and supporting NPCs is a cost-effective strategy to improve surgical access and reduce mortality in underserved areas.

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Area of Science:

  • Public health
  • Global surgery
  • Health systems strengthening

Background:

  • Limited surgical care access in low- and middle-income countries (LMICs) affects billions.
  • Non-surgeons often provide care in remote areas, highlighting a critical gap.
  • Essential surgical care is cost-effective yet not integrated into primary healthcare.

Purpose of the Study:

  • To define parameters for a public health approach to essential surgical care in LMICs.
  • To identify key surgical interventions for maximum impact on mortality and disability.
  • To explore the role of non-physician clinicians (NPCs) in delivering this care.

Main Methods:

  • Consensus meetings and targeted interviews informed the study.
  • A literature review assessed essential surgical care in Sub-Saharan Africa (SSA).
  • Interventions were selected based on simplicity, resource needs, and impact.

Main Results:

  • Fifteen essential surgical interventions were identified for district hospitals.
  • Training for these interventions is feasible for non-physician clinicians (NPCs).
  • NPCs already provide substantial surgical care in many SSA countries.

Conclusions:

  • A basic package of essential surgical care is crucial for scaling up services in LMICs.
  • Training, mentoring, and monitoring of NPCs are vital for successful implementation.
  • Utilizing NPCs for essential surgery offers a feasible, cost-effective solution to the surgical care deficit.