Increasing Access to Essential Surgery in Resource Restricted Settings: An Economic Analysis

Globally, 5 billion people lack access to safe, timely, and affordable surgical, obstetric, and anaesthetic care. Increasing access to surgery saves lives, promotes economic growth, and drives equitable global development. Essential surgery includes caesarean section, laparotomy, and open fracture treatment, otherwise known as the Bellwether procedures. Thesis objectives included conducting a systematic review examining cost-effectiveness of undergoing or increasing access to Bellwether procedures in resource restricted settings and performing an economic evaluation of increasing access to caesarean section for obstructed labour compared to existing care in the South African Development Community region. Our systematic review found that Bellwether procedures were likely to be highly cost-effective. Our economic evaluation demonstrated that increasing access to caesarean section to 80% costs $52.97 per disability-adjusted life year averted from a health systems perspective, relative to existing care (30% access). Future research should focus on improved estimates of cost, effectiveness, and unmet need related to essential surgery