Take Home Messages from WHO-Lancet Commission on Global Surgery National Surgical Forum, Delhi, March 2016

Presented at the WHO-Lancet Commission Meeting on March 11, 2016


who-lancet global surgery mtg pic 2The National Surgical Forum meeting arranged by the Lancet commission on global health and World Health Organization at Delhi was a unique one. It is probably the first time all the stake holders in rural surgical care were brought together under one roof to discuss about what could done to take surgical care to the poor and the marginalized in India. In addition to the two organizers WHO and Lancet there were representations from the Academia, from the Government of India, from the Medical Council of India, from the National Board of Examinations, from the Professional associations, from the rural and general surgery associations, from the Industry and the corporate hospitals.

The agenda was based on the needs of the rural surgeons that were documented after a workshop at Karad along with the Association of Rural Surgeons of India and International Federation of Rural Surgeons. Earlier a consensus statement was made known as the Karad consensus [1].


India, a nation of more than 1/7th of the world’s population, claims the dubious honor of the highest number of individuals without access to safe, affordable and timely surgical and anesthesia care. “This issue couldn’t be more pressing,” says Dr Nobhojit Roy, Commissioner and Chair, Health Delivery & Management Working Group, The Lancet Commission on Global Surgery.

India especially in the rural areas lags behind in the indicators that the Lancet commission has developed for indicating the adequacy of surgical care like the 2 hour access, the number of surgical procedures carried out per 100,000 populations, the number of surgical care providers per 100,000 populations and so on. Only 57% of hospitals in India provide comprehensive surgical care [2].

Until recently surgery was not considered a public health problem although 32% of the global disease burden is surgical.

There are gross inequalities in the number of undergraduate and postgraduate training programs and the completion for postgraduate training makes the doctors spend time in preparing for the entrance exams rather than utilizing what they have learnt in helping patients. Ninety percent of the undergraduate training programs are tertiary level hospital based and they do not train the students to take care of the needs in rural areas. The number of true general surgeons would dramatically decrease with the current trend in surgical training in India. The DNB program has successfully tried district hospital based DNB training in anesthesia and general surgery.

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