The Lancet Commission – ARSI/IFRS Karad Consensus Statement


The Lancet commission on global health was initiated about 2 years ago to address the current inequalities in delivery of global surgery and anesthesia care. The commission has over 100 publications from collaborators from 110 countries so far. The key findings are the following:

  • Every year there are more than 5 billion in the world who cannot access safe surgery when needed
  • To meet the surgical needs about 143 million surgical procedures are necessary every year but unfortunately the poorest third of the population receive only 6.3% of the surgical procedures performed all over the world
  • It is estimated that 33 million individuals face catastrophic expenses paying for surgery and anesthesia every year and an additional 48 million have catastrophic non–medical expenses seeking surgical care
  • It is estimated that 28 to 32% of global burden of disease is from surgical conditions

Spending more than 40% of the average non–food expenses is considered catastrophic. In most of the low and low–middle income countries any major surgical procedure means 56 percent chance of being impoverished. If the non–medical costs are included in many countries there is more than 94% chance of being impoverished after a cesarean section. Based on the data available the Lancet Commission developed six indicators that would help in evaluation of surgical care.

The Lancet Indicators are:

  • 2 Hr. Access – access to timely essential surgery
  • Surgical Volume – procedures done in an operating room per 100,000
  • Impoverishing Expenditure – protection against impoverishing expenditure
  • SAO/100,000 – specialist surgical workforce density
  • POMR – all-cause death prior to discharge patients
  • Catastrophic Expenditure – protection against catastrophic expenditure

Thanks to their work some of these indicators found their way into the list of 100 core healthcare indicators of the World Health Organization.
The Karad Consensus Statement was planned to kick start the Lancet Commission effort to evaluate and make recommendations for surgical care in rural areas in India. A team from Lancet Commission on global surgery, Association of Rural Surgeons of India (ARSI) and International Federation of Rural Surgeons (IFRS) worked together for months before the meeting at Karad on the consensus statement and prepared during the preconference meeting of the ARSI/IFRS conference at Karad in November 2015.

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