Barriers and challenges to achieving equity in global children's surgery: a call to action

Challenges:

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  1.7 billion children are deprived of surgical care due to economic, political and social factors that lead to inequitable healthcare.

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  90% of children live in LMICs where surgical ecosystems are often deficient with regards to children-specific infrastructure and health providers

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  Nearly half the population in LMICs lives in rural areas, however most surgical facilities are concentrated in urban centers with limited access due to poor infrastructure and costly or difficult transportation.

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  The cycle of poverty is difficult to break; it affects a family's ability to attain education and resources which can hinder the identification, understanding and treatment of surgical problems.

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  There is a lack of political will, both on regional and global fronts, to mobilize resources to improve surgical access in general, but particularly for children.

A Call to Action:

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  Children's surgery must be recognised as an essential component of both childhood and surgical care policies and initiatives.

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  To improve outcomes, the general health of a child must be made a priority. This entails promotion of a safe and healthy environment, good reproductive and antenatal health, along with regular checkups.

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  Local surgical systems must be strengthened by raising awareness, increasing training opportunities and improving infrastructure.

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  Health facilities should be categorized according to resource availability and there should be locally relevant expectations of care at each resource level. Referral systems must be developed to avoid late presentations and mismanagement.

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  Global health funders and political stakeholders must be engaged to raise funds for children's surgery, with a focus on equitable distribution of resources.

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  Population control may be a sustainable long-term solution to correct the disbalance between need and resources, particularly in rapidly growing countries with a poor economic forecast.