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With two thirds of the world's population having no access to safe and affordable surgery, a major report published today in The Lancet highlights the urgent need to invest resources in improving surgical care globally.

With two thirds of the world's population having no access to safe and affordable surgery, a major report published today in The Lancet highlights the urgent need to invest resources in improving surgical care globally.

Despite the overwhelming magnitude of the problem, today's Commission estimates that the countries where access to surgery is weakest could be scaled up to acceptable, and achievable, levels of access to surgery by 2030 with an investment of $US 420 billion, a cost far outweighed by the devastating economic cost to countries, communities, and families incurred by the current global shortfall in access to surgery.  This highly cost-effective investment in surgery needs to be accompanied by sustainable financing mechanisms across the health care system, say the authors, and a firm commitment to universal health coverage.

Professor Chris Lavy - Professor of Orthopaedic and Tropical Surgery at NDORMS and Consultant Orthopaedic Surgeon at the NOC, one of the co-authors, said: "This research highlights the staggering number of people - 5 billion - who lack access to safe, affordable surgical care when needed. 143 million additional surgical procedures are needed in low and middle-income countries each year in order to save lives and prevent disability. Our surgical colleagues are working to provide care in extremely tough circumstances, with often very limited resources, staffing, training and infrastructure. Also, this year the cost of accessing surgery and anaesthesia care will be catastrophic for 33 million households, forcing many into poverty. We are calling upon educators, funders and policy makers to join us in the goal of making safe and affordable surgery and anaesthesia care accessible to all by 2030."

Prof Lavy leads a team of NDORMS surgeons who have received a £246,000 grant to lead improved care for children with clubfoot in sub-Saharan Africa.

Globally, about 200,000 children are born each year with clubfoot, with 80% of these being in low and middle-income countries. Without treatment, the condition becomes 'neglected clubfoot', a painful and severely disabling deformity. However, in up to 95% of cases, clubfoot can be treated successfully using the Ponseti method of treatment, especially if this is initiated early.

Lead of the new Africa Clubfoot Training project, Prof Lavy said: "Clubfoot can be treated very inexpensively, straightforwardly and successfully by using the Ponseti method, which can change the lives of thousands of children who would otherwise face a lifetime of disability. We are delighted to work with our partners in CURE International and Global Clubfoot Initiative to make this a reality. Our project will also train new local instructors in over 15 countries in the region, and strengthen the existing national clubfoot programmes."

Leading a team of 15 healthcare professionals from across the UK, Prof Lavy and other leaders in the treatment of clubfoot from around the world will create new teaching materials using the Ponseti method and provide training in Ethiopia and Rwanda. The project aims to train 80 new clubfoot treatment providers and 60 new key trainers who will go on to deliver further local training.

Prof Lavy has worked to build up orthopaedic surgical care for children and surgical training programmes in Africa over the past two decades, and is co-director of COOL – a multi-country partnership programme between NDORMS and the College of Surgeons of East Central and Southern Africa (COSECSA). Surgeons and anaesthetists from Oxford University Hospitals have helped to deliver life-saving trauma training to healthcare workers in Sub-Saharan Africa.

COOL combines research and training in primary trauma care and musculoskeletal impairment across the ten sub-Saharan countries in the COSECSA region and aims to meet the critical need for more health workers trained in treating serious injury and musculoskeletal impairment. The project has coordinated the delivery of 53 primary trauma care training courses in 10 countries in Sub-Saharan Africa. These have trained over 1,800 doctors, nurses and clinical officers from over 180 hospitals (mainly in rural areas) in life-saving trauma care. A further 300 new local instructors have also been trained.

The Tropical Health Education Trust (THET) and the Department for International Development's Health Partnership Scheme fund both the COOL project 2012-16 and the Africa Clubfoot Training project for 2015 to 2017.

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