ICES Presents at the House of Parliament in London

ICES and The Right to Heal supported the case for making essential surgery a global health priority to an audience of the House of Parliament in London on April 3rd, 2014.


The All Party Parliamentary Groups (APPG) on Global Health and on Population and Development and Reproductive Health joined forces to host a panel on essential surgery and a screening of The Right To Heal. The Right to Heal is the documentary by ICES co-founder Jaymie Ang Henry that puts the spotlight on the people who are sentenced to death and disability due to a lack of access to safe and timely basic surgical care – and those who are working to change this.

The session was opened by Lord Bernard Ribeiro, vice chair of the APPG on Global Health, as he welcomed the audience to the Houses of Parliament he stated, “We’re here today to talk about surgery, not as a luxury, but as something that changes lives.”

The panel included:

• Dr Jaymie Ang Henry, Director and Executive Producer of ‘The Right to Heal’ and Executive Director, ICES • Mr Michael Cotton, Chairman of the Board, ICES • Dr Iain Wilson, Past President, Association of Anaesthetists of Great Britain and Ireland and Board Member, Lifebox Foundation.

The room was full of leaders in the field – the Royal Society of Medicine (RSM), the Association of Anaesthetists of Great Britain and Ireland (AAGBI), The George Institute, Tropical Health and Education Trust (THET), Lifebox, and The Lancet Commission on Global Surgery, among other distinguished guests.

The panelist introduced the philosophy behind the making of The Right to Heal, which included a discussion about why there is global inequity in access to essential surgery and explored some of the reasons for this phenomenon.

The statements that followed made a compelling case as to why the Global community must make essential surgery part of the public health dialogue and a public health and funding priority. Among them:

“People are dying unnecessarily, and with great suffering,” said Michael Cotton, surgeon, co-founder and chair of the International Collaboration for Essential Surgery (ICES). “It’s not necessarily complicated or expensive to deliver essential surgery, it’s a cost-effective, one-off intervention with life-long results. These are the things that really need to be done.”

The panel facilitated questions and a discussion that resulted in the following points of consensus:

• Education and training is vital for providers in LMICs who are already performing surgeries; regardless of whether they are clinical officers, doctors in training or other community workers. • There is a need to drive the Essential Surgery agenda forward and make it take its right of place in the Public Health forum amongst the sustainable development goals (SDG’s). • There is a need for integrated ethical training for medical electives in overseas environments, where there is opportunity to develop clinical/surgical skills. • Raising awareness about essential surgery as a form of primary care in communities afflicted by shortages is critical to increasing access to care. • Governments have a responsibility to be receptive to change and to acknowledge essential surgery as being necessary to meeting the Public Health agenda for non-communicable diseases.

The message of the film needs to be carried forward and out into the wider public domain – Dr. Henry discussed initiatives that have already successfully done so, as well other future plans.

Lord Riberio concluded the discussion, by stating that “there is a need to take this message forward and that there needs to be a plan to enable this to happen”. With the MDGs expiring in 2015 it’s a vital time to get surgery on the international agenda and Lord Riberio called for support from the Lancet Commission and the British Medical Association (BMA).

The message is clear; a lack of access to safe surgery is a global health crisis, but like tackling polio or HIV, increasing surgical capacity not an impossible undertaking. ICES is working to contribute the solution through increasing awareness, education of policy makers, research and innovations in surgical training models.

ICES Report -The Association of Surgeons in Training- Belfast, UK

Presentation at ASIT (Association of Surgeons in Training) Belfast, UK 29th March 2014.

Thanks to the invitation of the outgoing president, Mr Andi Beamish, The Right to Heal was screened at the Association of Surgeons in Training (ASiT) conference, the only UK-wide surgical trainee conference for all specialties. Professor Michael Cotton, Chairman of ICES gave an abbreviated outline of the purpose and goal of ICES. This was followed by a presentation by Dr. Jaymie Henry, Executive Director of ICES, of the global advocacy efforts around Essential Surgery via the 15x15 campaign.

Over 600 delegates had gathered in Belfast’s spacious auditorium, where only a few months earlier, US President Barack Obama had adressed the G8 summit. Your ICES presenters felt not just a little awed at the prospect of speaking to such a large audience, which included all four presidents of the British and Irish Royal Colleges of Surgery, rarely present all together at any one event.

This was thus a huge privilege, as well as a great responsibility.

During the showing of the Right to Heal film the audience was hushed in rapt attention: indeed, when the viewing had finished, you could have heard a pin drop. Furthermore, during both talks, the same fixed concentration was virtually palpable throughout the auditorium.

Numbers of surgical trainees afterwards presented their compliments, and registered their keenness to get involved.

There was no doubt that the UK Surgeons of the future were as enthusiastic for the aims of ICES, as they were afterwards at jiving to the excellent sounds of the medical band, the Arythmics, in the grand replica dining hall of the Titanic, recreated in Belfast’s dockland.

Tanzania proposes increasing access to essential surgery as a sustainable development goal post-2015

The International Community Calls for a “Right to Heal” to improve child and maternal health, to save lives and for Essential Surgery to become a health priority for the global agenda for the post-2015 Sustainable Development Goal. “Surgical interventions play a major role in helping to prevent death and chronic disability. Despite this fact, surgical interventions are not accessible by everyone.”

On February 6, 2014, the International Collaboration for Essential Surgery (ICES) hosted its first UN Side Event in conjunction with the 8th and final Open Working Group on Sustainable Development Goals (post-2015). This official UN event focused on how women and children are unnecessarily suffering from health issues easily remedied by essential surgery.

The event also included a special screening of the Right To Heal.

The lack of essential surgery is a worldwide problem that is often hidden from view and is impacting the ability of women and children to fully participate in their economies and communities.  Two out of every seven people on the planet lack access to basic surgical care, and most live in low- and middle-income countries. Women in developing countries who survive obstructed births are often disabled and injured due to obstetric fistula and infection- conditions that damage the reproductive tract and structures near the birth canal, causing incontinence and pain.  These women are abandoned, outcast by society and denied their fundamental rights to health and wellness. Children who are born with severe disabilities are robbed of their potential in infancy. By increasing access to the most essential surgeries, these issues can be addressed. By ensuring their “right to heal,” these women and children will be empowered to reach their full potential as productive and equal members of society.

Without a focus on essential surgery, the crisis is one of access and priority. Speaker after speaker emphasized how women are dying and suffering from conditions associated with obstructed labor and pregnancy.  Speakers at the event included:

Ms. Anita Sharma, Senior Director, Millennium Development Goals Initiatives, Every Woman, Every Child, UN Foundation welcomed the group and reiterated UNF’s commitment to women and children. She linked the need for essential surgery to the global movement to improve the health of women and children around the world and spoke of the importance of meetings such as the side event that unite leaders from government, the private sector and civil society in prioritizing women's health.

Ms. Ellen Maduhu- Second Secretary of Social Humanitarian and Cultural Issues, Women, Children in Armed Conflict, Refugees, IDPs, a representative from the Tanzania Permanent Mission to the United Nations; set the tone for the UN-approved side event on the role of surgical access and women’s equity. She then made a proposal on behalf of the Tanzanian Government that essential surgery be included as a sustainable development goal in the post-2015 agenda within the framework of universal healthcare.

Official Statement from the Government of Tanzania

Maya Azucena -  Global Singer, Cultural Ambassador and human rights activist spoke on the right to hope and that no woman should ever be a burden, but allowed to achieve their truest potential.

Gillian Slinger – Campaign to End Fistula, United Nations Population Fund, spoke passionately about the public health crisis of fistula and the real dangers faced by women with fistulas during subsequent deliveries. She further emphasized that these women are the most marginalized people in society, denied of their basic right to live and work where they choose because of their condition.

ICES' cofounder, Jaymie Ang Henry, MD, MPH emphasized that half of the world is female and that neglected conditions treatable by surgery are becoming a leading cause of death globally. “It’s imperative that we take action to ensure that women and children have access to essential surgery.  Women and children are dying in childbirth and from other conditions because they don’t have access to the most basic surgeries like caesarean section- surgeries that can and do save lives during obstructed births.  I myself survived childbirth because I had access to essential surgery.  No woman should fear injury or death during childbirth.”

“Despite global achievements and our commitments, actions need to be taken beyond 2015 to ensure that women do not die while giving birth. Governments such as mine (Tanzania) despite our good intentions and commitments are very much constrained.  We still need the support from different stakeholders like the United Nations system, our development partners, the private sector and civil societies to look for an effective workable strategy beyond 2015 that will end preventable deaths among children and women.”  said Ms. Maduhu.

All speakers called for universal support for essential surgery as a global priority. Representatives from the governments of the USA (Health and Human Services, HHS), Tanzania and Belgium convened with a community of NGOs, academia, and corporate leaders working to address maternal mortality and to explore how to advance access to essential surgery to women and children. The HHS expressed their continuing support for surgical care at the World Health Assembly and outlined their efforts in drafting a resolution for surgical care and anaesthesia in collaboration with stakeholders across multiple sectors.

The event was hosted by the International Collaboration for Essential Surgery, International Federation of Surgical Colleges, and the Association of Surgeons of Great Britain and Ireland with Johns Hopkins University as a collaborating partner. The UN Foundation provided the venue for the event.

Attendees include representatives from:

Operation Smile, Kupona Foundation, Doctors Without Borders/Médecins Sans Frontières, Smile Train, Lifebox, Gradian Health, Johnson and Johnson, Jhpiego

The next era of global health: ICES and the Post-2015 Development Agenda

For over a decade, the Millennium Development Goals (MDGs) have been a guiding force on many issues affecting global health.  Progress has been made in improving maternal health, reducing preventable childhood deaths, and in lowering the transmission rates of communicable diseases. There is also a shared understanding and awareness of the linkages between health and poverty. That being said, much work remains – both on the unfinished and continuing agenda of the MDGs and in addressing critical issues not adequately covered by the MDGs.

The lack of access to essential surgery for the world’s poor is one of the biggest global health problems that no one has ever heard of and is conspicuously absent from the MDGs and the post-2015 Development Agenda.

The disease burden in low- and middle- income counties has seen a significant shift towards non-communicable diseases and trauma. According to the World Health Organization, 2 billion people in the world have no access to basic surgical care. 180 million people globally suffer from the conditions essential surgical iInterventions can easily treat. Simply put, for the first time in history, you’re more likely to be killed by a surgically-treatable condition than a communicable disease in certain parts of the world.

The MDGs are set to expire in the year 2015, and, while the focus needs to remain on continuing to achieve progress on these goals, individual citizens and development actors alike are already thinking about what the next era of development – post-2015 – should look like.

ICES is firmly committed to ensuring that global health- and that the wellness of women and children – remain at the centre of the next development agenda, as they have been with the MDGs.

We believe that it is time to expand our sense of urgency beyond communicable and infectious diseases and to articulate specific essential surgical goals and measures for the next development agenda. We call for urgency in addressing a second global scourge: the diseases of modern times which can be easily treated through increased access to essential surgery.

Let us look with hope and determination to a time when no family grieves the loss of a mother because her labour was obstructed, where no mother suffers the pain of burying a child whose burns and wounds were not properly treated, and no one needlessly suffers a lifetime of disability from easily treatable conditions.

Tomorrow, we are engaging with UN agencies, governments, NGOs, humanitarians, and all humans alike who believe that it is time to talk about essential surgery and their role in empowering women and children in the post-2015 era. People lie at the heart of sustainable development and it is time to include them in the conversation.


ICES Publication Announcement for the ISS, World Journal of Surgery


ICES, International Collaboration for Essential Surgery is proud to announce the publication of “Cost-effectiveness of Surgery in Low- and Middle-income Countries:  A Systematic Review”, in the World Journal of Surgery, Official Journal of the International Society of Surgery/Societe Internationale de Chirurgie, published online on October 8, 2013. Co-Authored by Michael Cotton, MA, ICES Founder and Chair, Dr. Caris E. Grimes, Dr. Jaymie Ang Henry, Founders & Executive Board, and Dr. Nyengo C. Mkandawire, Executive Board; this collaborative effort produced a paper that outlines the provision of essential surgical care as a part of public health policy in low- and middle-income countries.

Examined are the cost-effectiveness of simple surgical interventions which could be made available at any district hospital and are compared to standard public health interventions that have been shown to prevent death and disability.  Suitable articles with both cost and effectiveness data were identified and, where possible, data was extrapolated to enable comparison across studies.

The paper is an excellent representation of the ICES goals in bringing cost effective Essential Surgery to developing countries with the need for data and information that must be disseminated to further build the infrastructure that must be put in place to affect changes.

In conclusion, the authors recommend that further studies be carried out to assess the impact on death and disability rendered by simple surgical procedures in low resource settings.

The Outcome:

“We recommend an investment in surgical care and its integration with other public health measures at the district hospital level, rather than investment in single disease strategies”.

The final publication can be found at:  Cost-effectiveness of Surgery in Low- and Middle-income Countries: A Systematic Review  or

This article available will soon be made available in .pdf format in ICES digital library at

ICES Receives Award, International Surgical Week in Helsinki, Finland

The International Surgical Week was held in Helsinki, Finland August 25-29, 2013, where ICES chair Michael Cotton presented a paper on the Global Need for Essential Surgery, to attendees comprised of surgical societies from countries throughout the world. The paper was well received by the surgical community and was awarded “The Article of the Year”. Congratulations go to ICES and a thank you to the ISW community for the recognition.

At the conference, International leaders presented their ongoing work and projects for improving surgical care throughout the world to share novel ideas, approaches and resources on global surgical best practices.

Key discussion points raised during the conference from:

Sats Pillay, South Africa, ISS Secretary and Treasurer, asserts that at the current rate of training, "We will NEVER, EVER train enough surgeons to take care of the surgical needs of Africa", and so require that we think out of the box to address these needs.

Ian Ritchie, President Elect, Royal College of Surgeons of Edinburgh, echoed the need to think outside the box and come up with more immediate solutions.

The body of college leadership was challenged to determine what role they should play in a new approach to training and meeting the surgical needs of countries globally.

The facts remain:

2 Billion people worldwide have no access to surgery.

The poorest 1/3 of the world’s population receive only 3.5% of all surgical procedures performed.

>70,000 maternal deaths can be prevented with timely surgery. The recommended C-section rate is 5-15%, some believe it is closer to 20%. Developing countries show between 1-3% C-section rate, grossly under acceptable standards.

Manjul Joshipura presented updates on the WHO Global Alliance for Care of the Injured (GACI) and averred that 2 million lives can be saved with proper trauma care systems.

Brent Eastmann, president of the American College of Surgeons, states: "Train local providers- you will leave and they will stay".

With the overwhelming information and figures presented, it is evident that the lack of quality surgical care is now too large of a global health issue to ignore.

This event has opened a new dialogue among surgical leaders in terms of what can be done to foster change and create a proactive paradigm. Several ideas are circulating and require a consensus, with the importance of groups organizing into collective action to make effective and far reaching changes to current programs; to bring timely surgical care to the neediest people worldwide. ICES has been moving forward in its advocacy and efforts to unite the surgical and anesthetic community to bring the message that the world needs good, safe, and quality surgical care today.

Details available here:

House of Lords informal meeting 23rd July 2013

ICES Executive Board members Bob Lane, Michael Cotton, Caris Grimes and colleague Andy Leather attended an informal meeting with Lord Nigel Crisp (formerly Chief Executive to the NHS and a passionate advocate for Global Health) and Lord Bernie Ribeiro (past president of the Royal College of Surgeons and Patron to Operation Hernia).  The group had a long discussion around the issues for improving access to essential surgical care and how best to gain UK political support to cause movement on the Global Health Stage for encouraging sustainable surgical training partnerships between low- and middle-income and high income countries.

The Right to Heal Film Premiere

"The Right to Heal", a film about essential surgery, made its United States Premiere at the Inaugural Bay Area Global Health Film Festival at Public Works in San Francisco, California on July 12, 2013. The first year festival was co-organized by Amber Caldwell, Director of Development at Institute for Global Orthopaedics and Traumatology (IGOT), Jaymie Ang Henry, M.D., M.P.H., Founder & Executive Board Member, International Collaboration for Essential Surgery (ICES), and Zak Armitage, Marketing Manager at LIM Innovations. The festival attracted an audience of over 300.

Amber Caldwell kicked off the event with a warm welcome and introduction to guest speaker, Dr. Thomas Weiser from the Department of Trauma Surgery & Surgical Critical Care at Stanford University, who delivered a global health message focused on a new paradigm in bringing surgery to the world stage.  Dr. Jaymie Ang Henry spoke of how the film 'The Right to Heal' aims to shed light on the neglected issues in surgical care globally and the need for concerned individuals and organizations to unite in bringing international attention to issues in providing essential surgery to poorly-served areas of the world.

'The Right to Heal' gave us an intimate look at the lives of individuals in need of essential surgery and their incredibly inspiring and innovative providers who are looking for solutions and change in global surgical care.

Dr. Jaymie Ang Henry, co-producer and Director, along with James Carroll and Alemberg Ang, brought us compelling storytelling and beautiful images of people affected by disabilities that are easily treatable, such as cleft lip and clubfoot, and women affected by the consequences of not having timely, safe, and appropriate cesarean section resulting in fistulas, the appalling life they are submitted to, physically and socially, and those who are disabled for life as a result of little or no access to essential surgical care.

Filmed thus far in developing rural areas in the Philippines, Tanzania, Kenya, Malawi, and Bangladesh, they will grow their film by adding stories from their upcoming filming in Ecuador, Cambodia and Mongolia.

Brought to us by San Francisco filmmaker, director and writer Mike Seely, “The Most Distant Places” follows Dr. Edgar Rodas and his team to the far reaches of Ecuador, interweaving intimate portrayals of the challenges of providing health care for impoverished people located far from adequate medical facilities.

Also screened at the event was "Losing a LIMb-Life without your Own 2 Feet" by Ray and Andy Burson.  The filmmakers are brothers and surgeons whose mission is to empower, educate, and train communities about prevention, management, and the consequences of diabetes and amputation.

Global Health Organizations partnered for the event were:  IGOT Institute for Global Orthopaedics and Traumatology, ICES International Collaboration for Essential Surgery, Own2Feet, A little4alot, LIM Innovations, UCSF Global Health Sciences, Samahope, ReSurge, and LifeBox.  To connect please visit:


The event created exposure for 'The Right to Heal' to the surgical and global health care community and highlighted the need for global essential surgery which has resulted in invitations for screenings at festivals and organizations throughout the US and abroad in the coming weeks and months which will serve to promote the filmmakers message to increase awareness. Please visit the film's website at for upcoming events/screenings.

Leave No One Behind: possible without increasing access to Essential Surgery? Our response to the UN post-2015 High Level Panel report

Joint response from the International Collaboration for Essential Surgery (ICES), Alliance for Surgery and Anesthesia Presence (ASAP), and Comprehensive Community-Based Rehabilitation in Tanzania (CCBRT)

We applaud the recommendation of the High Level Panel (HLP) to “eradicate extreme poverty in the context of sustainable development.” We agree that no one should be left behind and that if we ever hope to attain true progress as a human race, we need to focus on the most vulnerable, disadvantaged, and marginalized segment of society. We would like to echo the statement that “the new agenda must tackle the causes of poverty, exclusion and inequality” (p.7) and emphasize the importance of ensuring “access to and availability of adequate health care as an issue of basic social justice.” Moreover, we support the statement that “many people living in poverty have not had a fair chance in life because they are victims of illness or poor healthcare…”

Every year, more than 100 million people are affected by injuries, up to 3 million women live with severely debilitating obstetric fistulas, 5 million children suffer from congenital conditions such as cleft lip/palate and clubfoot, and 20 million suffer from cataracts. Yet stark inequality in accessing basic surgical services is a reality. Only 3.5% of all surgical procedures worldwide are performed in the poorest third of the world, with 75% of of procedures performed in the richest third. 2 billion people worldwide lack access to the most basic surgical care and health systems in low resource countries do not have adequate resources to meet the great need.

There is a clear link between disability and poverty. In recognizing this, we should implement goals and frameworks which prevent severe disability, such as improving the quality and safety of healthcare, ensuring access to timely essential surgical care such as cesarean section for obstructed labour, emergency care for victims of trauma and injury, and essential surgical care for vulnerable children born with congenital defects.

We agree wholeheartedly that a paradigm shift is imperative. This needs to reach the neediest and most vulnerable populations, starting with developing strategies to strengthen and expand health services to ‘reach those not adequately covered by existing programmes.’ (p.8) In this regard, we support the second transformative shift, namely putting sustainable development at the core, but we would wish to emphasize that investments in strengthening health systems should be a priority.

We also support the idea that local authorities “form a vital bridge between national governments, communities and citizens and will have a critical role in a new global partnership” especially in setting and executing priorities and engaging with local communities. Local authorities should be empowered to deliver essential health services to local and rural populations. There is a need to improve and strengthen the capacity of hospitals at district level to provide essential medical and surgical care, with a focus on prevention of death as well as severe disabilities and consequences of delayed presentation.

Lastly, we commend the emphasis on improved data collection for monitoring and evaluation. This exercise serves to measure the burden of disease, helps to set targets for improvements, and builds the case for the need to expand services. Improved data collection tools for surveillance and monitoring of service delivery, particularly in the provision of essential surgical care, will serve to guide policies and quality improvement initiatives.

No one left behind?

Although we accept the emphasis on eradicating extreme poverty and building sustainable development, the report fails to address some vital issues.

There is no mention of essential surgical services, which are crucial to saving lives and preventing permanent disability. These services include surgical care for maternal complications of childbirth, which accounts for 20-30% of maternal deaths. It also includes correction of congenital deformities, which occur in one in every thousand births. It has been estimated that essential trauma care, through surgery, could save 2 million lives every year. Injury alone causes 24.4% more deaths and 23.3% more disability* than HIV, TB and malaria combined. Every year, between 30 – 130,000 women develop an obstetric fistula in Africa alone, resulting in significant social and economic consequences. Furthermore, this disease is one example of the failure of the health system to provide women with adequate surgical care.

Despite doubling of investments in maternal health in the last 5 years, only 13 countries are on track to reach the 5th Millennium Development Goal, which is to improve maternal health. More than 250,000 children are born every year with clubfoot, and about 250,000 more are born with cleft lip and palate, both of which are amenable to surgical correction, sometimes through simple techniques which could be made locally available such as the Ponseti method for clubfoot correction. Many children go untreated and live their lives with this disability which has resulting social and economic consequences. There are currently no national, international, or global frameworks for addressing these conditions at the policy level. Surgical care continues to receive little attention or funding. It is not currently recognized as a political priority among public health professionals, governments, funding agencies, and ministries of health despite growing evidence of its magnitude and the simplicity of many of its solutions. Basic, essential, and life-saving surgical care does not exist in many parts of the world. Moreover, the surgical health workforce is scarce and often ill-equipped to provide even the most basic surgical care in remote and rural areas. If we are aiming to “leave no-one behind,” (p.13) we need to explicitly address these surgical issues as part of a primary care strategy at the public health level, and call for a paradigm shift in public health service delivery.

There is a need to focus on strengthening health systems as an essential part of sustainable development. The workforce shortage in developing countries serves as a major barrier in the provision of and access to quality healthcare services. There is an estimated global deficit of 4.2 million health workers. In 2006, the World Health Organisation (WHO) estimated that 57 countries were at crisis point with fewer than 2.3 nurses, doctors and midwives per 1,000 people. This particularly affected sub-Saharan Africa and parts of Asia.

It is imperative that attention and priority is focused on building surgical capacity as a primary care component in national health systems. Although infrastructure is desperately needed, it also essential that the health workforce is trained to provide the basic, essential, life-saving and disability-preventing surgical care. Such care is not expensive or complicated. Moreover, there needs to be a focus on strengthening training in primary surgical services for health care providers at rural clinics and district-level facilities. This may best be implemented by the provision of modular training in essential surgical procedures.

Lastly, there should be a call to government agencies to create policies to provide incentives for trained surgical healthcare professionals to cooperate in strengthening surgical capacity in underserved areas by the training of health workers to provide essential surgical care, and the creation of incentives such as career development in order to increase retention.

ICES, ASAP and CCBRT remain committed to post-2015 discussions to ensure that essential surgical services are recognized as part of the basic human right to health. Surgery has the potential to result in a tremendous impact on society and has the capacity to restore disabled individuals into active, economically-productive members of society through relatively simple measures. Surgery should no longer be considered as a privilege only for the rich of the world.

The 12 goals

We commend the HLP for the 12 illustrative goals and evidence of impact, and particularly welcomes goals 1, “End Poverty,” 2, “Empower Girls and Women andAchieve Gender Equality,” and 4, “Ensure Healthy Lives.”

We believe that providing the poor with social protection systems and enabling them to build resilience can result in the empowerment of people to lift themselves out of poverty. It also provides them with the tools necessary to achieve health and well-being.

We fully support the desire to address social issues involving women such as ending violence and child marriage, which itself leads to maternal health problems and resulting surgical disease.

A strong emphasis on “ensuring healthy lives” is crucial to building healthy and economically- productive societies. We support a strong emphasis on health systems and are encouraged by the inclusion of ‘local surgical capacity’ as an affordable and available solution. However, we note that this is not included as a targeted goal under ‘reducing the burden of disease.’


We strongly recommend the following amendments.

Goal 4 “Ensure Healthy Lives”

Universal access to basic healthcare must encompass access to safe essential surgical care.

Target 4e: Reduce the burden of disease from HIV/AIDS, tuberculosis, malaria, neglected tropical diseases and priority non-communicable diseases.

This target should include essential surgical services not only as part of non-communicable diseases, but also because of the surgical complications which result from infectious disease. Simple, affordable solutions exist that are feasible to implement at the public health level and these should be available to local communities. Moreover, the target should involve sensitizing the communities to seek early and proper medical service. The group has targeted 15 essential surgical interventions which, in previous studies, have shown to address approximately 80% of the basic surgical needs of any developing country. These priority surgical services should be part of national health policies. Strategies for training providers, implementation and strengthening of district level services as well as improving the referral system to tertiary institutions need to be advanced.

We believe that true universal health care cannot be achieved without a focus on a comprehensive set of health services. Surgery is in a unique position in that it impacts on almost every other medical specialty. Furthermore, there is anecdotal evidence that equipping local and rural hospitals with the ability to provide simple essential surgical care acts as an enabler, raising the quality of care across the hospital. It also increases the credibility of the hospital.

It is no longer acceptable that mothers die in childbirth because of lack of access to surgical services, or that 75% of children fail to reach their 1st birthdays because of easily correctable congenital deformities, or that men, women and children of all ages die or become severely disabled from injuries because of a lack of access to timely emergency care. If we are going to address healthy lives in the truest sense, this cannot and must not be ignored.

Silos and ‘vertical’ programs fail to address the power of strong, integrated health systems that maximize use of resources for the good of the community. Trained surgical workers can also take care of the non-surgical needs of the community. The ability to provide high quality, safe surgical services builds the community’s trust in the health system.

Contributors: Jaymie Ang Henry (ICES) Caris Grimes (ICES) Tamaly Lutufyo (CCBRT) Kelly McQueen (ASAP)



ICES meeting at Royal College of Surgeons (Eng) 7th June 2013

Members of the ICES Executive board met up with Ruairi Brugha, RCSI/COST Africa project and Eric O'Flynn, Programme Manager, RCSI/COSECSA  This was an important discussion forum to share progress to date, inspiration, news and future plans including presentation of the 15 by 15 campaign.  This exciting and innovative campaign aims to ensure that cost effective and essential life saving surgery is promoted as a key global health improvement catalyst worthy of significant investment.

ICES was delighted to welcome a regional Surrey surgeons group, named LAST (Links in Africa for Surgical Training) who aim to provide training and support to Clinical Officers in Malawi at the invitation of the Malawi College of Medicine - this vital initiative will link into the work of COST Africa.

Become a friend of LAST at