Surgery Could Save Millions of Lives in Developing Countries

March 26, 2015


  • A new book, “Essential Surgery,” says greater access to surgical care in developing countries could avert 1.5 million deaths a year.
  • Basic surgeries such as setting broken bones or delivering babies via Caesarean section are among the most cost-effective health interventions in developing countries.
  • “Essential Surgery” is the first of nine volumes in the “Disease Control Priorities” series to be published by the World Bank Group in 2015 and 2016.

Five million people died of injuries in 2012, and 270,000 women died of pregnancy complications. Many of these deaths could have been prevented if people had better access to surgical care, says a new book published by the World Bank Group.

Essential Surgery, launched at the Consortium of Universities for Global Health sixth annual conference in Boston, is the first of nine volumes of the third edition of Disease Control Priorities (DCP3), a comprehensive review and analysis of the most effective and cost-effective approaches to global health.

The book finds that basic surgical procedures are among the most cost-effective of all health interventions in developing countries. If they were more widely available, essential surgical procedures would prevent 1.5 million deaths a year.

About 2 billion people lack access to surgical services such as Caesarean sections or setting broken bones, even though many surgeries could be offered at district hospitals in developing countries.

Until relatively recently, surgery was considered too complicated and expensive to be an integral part of public health in developing countries. But opinions are changing as more evidence emerges of the value and cost-effectiveness of basic surgical procedures.

“You’ve got a broken arm or a ruptured appendix … everybody knows you need a surgeon. And it turns out that kind of surgery is not that hard, not that expensive, and it really makes a big, big difference,” said DCP3 and Essential Surgery editor Dean Jamison, senior fellow in Global Health Sciences at the University of California, San Francisco, and an emeritus professor of global health  at the University of Washington. Jamison was also lead author of the original Disease Control Priorities in 1993, as well as of the 1993 World Development Report, Investing in Health.

Dr. Haile T. Debas, another Essential Surgery editor and a surgeon, said he has seen firsthand the “incredible lack of essential surgeries, particularly in rural districts” on his visits to his native Eritrea and elsewhere in Africa.

DCP3 and its predecessor, the 2006 edition of Disease Control Priorities, “have really helped put surgery on the global health map,” said Debas.

“I think many people are coming to appreciate that unless you can provide essential surgery services in low- and middle-income countries, it will be very hard to realize the lofty goals of the Lancet Commission on Global Health 2035. The need for surgical services is very big.”


A hospital in Cambodia's remote Preah Vihear province has modern surgical equipment.

Chhor Sokunthea/World Bank

" You’ve got a broken arm or a ruptured appendix … everybody knows you need a surgeon. And it turns out that kind of surgery is not that hard, not that expensive, and it really makes a big, big difference. "

Dean Jamison

DCP3 and Essential Surgery editor

Essential Surgery identifies 44 procedures as essential to provide in developing countries, including those that treat injuries, obstetric complications, abdominal emergencies, cataracts, and congenital anomalies, among others. It estimates that universal access to this set of procedures would prevent 6% to 7% of all preventable deaths in low- and middle-income countries.

Such procedures rank among the most cost-effective of all health interventions and are feasible to promote globally. Many could be delivered at the first-level hospitals, says the book.

The book adds that the cost-effectiveness of essential surgical services along with strong public demand for them suggest that “universal coverage of essential surgery should be implemented early on the path or universal health coverage.”

The third edition of the Disease Control Priorities series is the product of a multi-year project funded by the Bill & Melinda Gates Foundation and coordinated by the Disease Control Priorities Network at the University of Washington’s Department of Global Health. DCP3 is a comprehensive review of global health knowledge and evidence, combined with economic analysis, to identify ways developing countries can improve health care and save more lives despite tight health budgets.

The series defines packages of essential services and estimates their costs, drawing on evidence from countries, said DCP3editor Rachel Nugent, a professor in the Department of Global Health at the University of Washington. DCP3 uses a method called “extended cost-effectiveness” to better measure how equitably health services are distributed across groups of people, and whether interventions affect people differently, she said.

“We thought it was very important for policymakers to know, when they make decisions about how to spend money, who is going to be affected. If they want to have pro-poor health care and policies, how would they do that? That’s one of the ways we wanted to advance the knowledge about global health,” said Nugent.

Upcoming DCP3 volumes include:

  • Cancer, 2015
  • Reproductive, Maternal, Newborn, and Child Health, 2015
  • Mental, Neurological, and Substance Use Disorders, 2015
  • Cardiovascular Respiratory, Renal, and Endocrine Disorders, 2015
  • HIV/AIDS, STIs, Tuberculosis, and Malaria, 2015
  • Injury Prevention and Environmental Health, 2016
  • Child and Adolescent Development, 2016
  • Disease Control Priorities overview, 2016