Table 1 Country progress in surgical system strengthening [1, 2]
Country | Population (2021) | GDP per capita (2021) | CHE (% GDP) (2019) | LE (2020) | NSOAP stage | Achievements to date | Challenges | Proposed Solutions & Next Steps |
|---|---|---|---|---|---|---|---|---|
Tonga | 106,760 | 4,624 (2020) | 4.98 | 70.9 | Drafting | - Secured political commitment, educated political leaders - Conducted baseline situational analysis - Stakeholder consultation workshop - Drafted the NSOAP | - Education & training - Transportation limitations | - Launch and implement its NSOAP |
Cook Islands | 17,565 | 14,822 | 3.07 | 76.9 | Stakeholder engagement | National surgical planning: - Conducted baseline situational analysis Targeted interventions: - Collaborations on climate change mitigation and sustainability - Use of solar power | - Access to quality training - Climate change - Antimicrobial resistance - NCDs | - Decentralise health services - Integrate surgical care with prevention - Increase spending to train professionals - Strengthen IPC |
Fiji | 902,899 | 5,086 | 3.82 | 67.4 | Drafting | National surgical planning: - Appointed a national coordinator for safe and affordable surgery - Conducted baseline situational analysis - Stakeholder consultation workshop Targeted interventions: - Significant increase in healthcare worker numbers - Increase in scholarships - Service remodeling to decentralise care | - Geography - Transportation - The COVID-19 pandemic - The rising cost of surgical education | - Strengthen surgical care capacity in first-level hospitals - Remote training - Integrate surgical services with public health and emergency preparedness |
Malaysia | 32,776,195 | 11,371 | 3.83 | 76.6 | Commitment | National surgical planning: - Formed a core working group - Developed a two-phase plan to implement safe and affordable surgery - Assessed surgical needs in 5 out of 13 states - Designated POMR as a key performance indicator Targeted interventions: - Developed a national obstetric database - Anaesthesia task-shifting program | - Poor data quality - Large rural population - Workforce sustainability in Eastern Malaysia | - Conduct site visits in the remaining states - Hold a national forum - Develop an NSOAP - Set achievable standards for workforce training and safety |
Nepal | 29,674,920 | 1,223 | 4.45 | 70.8 | Commitment | - Universal access to emergency care - Subsidised the treatment of many surgical conditions - Anaesthesia task-shifting program - Integrated surgery into national health policy and strategies | - Long wait times for elective surgery - Mountainous geography | - Convene stakeholders - Develop an NSOAP |