Background
Surgical services in low- and middle income countries (LMICs) must be considered within
the context of a coordinated strategy for building primary care systems. Weak front-line
primary care systems lead to delayed presentation and poor follow-up of patients with
surgical illness, increasing the risk of poor outcomes.
Methods
Here we propose a framework to integrating surgery and primary care, organized around
basic primary care principles of access, longitudinal care, coordination, integration
and equity.
Results
Making surgical care accessible will require frontline provider capacity to screen
for and recognize common surgical conditions, as well as to deliver certain basic
surgical services themselves. Making this care effective will require strengthening
the capacity of interdisciplinary teams to provide longitudinal care, involving coordinated
networks for referral, communication with and mentorship by more specialized providers,
and postoperative follow-up. Innovative approaches to information and communication
technology can help to overcome the transportation and infrastructure barriers that
jeopardize both access and effectiveness. Explicit integration of surgical and primary
care programs at the managerial and administrative levels, as well as at the point-of-care,
will also be critical. Taking a pro-equity approach can ensure that populations with
the greatest unmet needs are effectively reached.
Conclusion
Utilizing the pillars of effective primary care as a guiding framework to design,
implement, and scale surgical programs in LMICs offers an opportunity for strengthening
and enhancing the quality of health systems as a whole.
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Article info
Publication history
Published online: April 27, 2015
Accepted:
March 3,
2015
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
