To improve children’s health in low-income countries, put pediatric surgery on par with preventing malaria or HIV

The devastation caused by malnutrition, HIV, tuberculosis, and malaria in low income countries is well known in the U.S. and other high-income countries, due in part to masterful marketing that has elevated these diseases into the collective consciousness — and convinced many people to open their wallets.

But this narrow focus on fundraising and aid limits the public good that comes from investing in child health. In new research, a partnership between the World Pediatric Project, William & Mary, and the University of Ghana found that a broader approach that includes pediatric surgery extends life, prevents disability, and is well worth the attention of philanthropic supporters.

For funders and donors who want to make the biggest difference for sick kids, these findings are a game-changer.

The health care needs of children in resource-limited countries are profound, extensive and varied, ranging from infectious and maternal diseases, to noncommunicable diseases and injuries. More than 5 million children died before their 5th birthday in 2020. Most of these deaths occur in low-income countries where children are 14 times more likely to die before reaching age 5 than children born in high-income countries.

Some of these children could have been saved with simple and affordable surgical care. Without it, treatable illness such as infections, injuries, complications of childbirth, congenital anomalies, and noncommunicable diseases can be fatal. Yet investing in surgical services has been limited. Too often, children do not receive surgical care, because there is a lack of available expertise, infrastructure, or supplies. As a result, routine conditions can become tragic by progressing to a disease with a high mortality rate. Without sufficient funding, scaling up the surgical services is not possible.

The global community has invested billions of dollars in preventing HIV, tuberculosis, and malaria even as many children continue to die from these diseases. Largely overlooked is that the number of children dying because they didn’t get the surgical care they needed surpasses the number of deaths from HIV, tuberculosis, and malaria combined.

By supporting a variety of specialized surgical interventions, donors can have an even larger impact on children’s health. Organized and executed holistically, these interventions help children bounce back from life-threatening emergencies to enjoy rich, full lives.

Recent research that one of us (C.B.D.) participated in leveraged data collected by the nonprofit World Pediatric Project between 2002 and 2019 that included surgical procedures performed by visiting specialists through the organization’s Caribbean Programme. This analysis showed that investing in surgery is affordable and saves lives. In this group of children, 914 procedures added 5,815 healthy years of life. It also found that most surgical interventions were cost-effective — in terms of improving health outcomes — and that pediatric interventions in particular are instrumental for programs meant to improve youths’ health in resource-limited environments.

It isn’t only surgery itself that makes a difference. Positive outcomes of the procedures have increasingly benefited from, and relied on, a network of physicians located in St. Vincent and the Grenadines, as well as in the United States. Referrals to other specialists, consultations and postoperative follow-ups help ensure that patients follow a path toward long-term recovery and avoid serious postoperative complications. Without these networks, recovery would be impossible, more complicated surgeries inevitable, and disability a permanent part of children’s lives.

The United Nations, under the Millennium Development Goal 4 (reduce childhood deaths) and the Sustainable Development Goal 3 (ensure healthy lives and promote well-being for all at all ages), has reaffirmed its commitment to ending preventable deaths of newborns and children under 5 years of age. If these goals are to be met, then it is time to double down on the evidence that increasing pediatric surgical care in resource-limited settings is a good investment. Global surgery represented just 11.5% of charitable organizations’ investments in health care in low- and middle-income countries in 2013.

The global health funding community, including philanthropic organizations, bilateral aid agencies, multilateral organizations, and private foundations, needs to invigorate a commitment to fund surgical systems and expand pediatric surgical care in resource-limited countries. Without an increased commitment to providing consistent and reliable fiscal support for surgical and anesthesia care, it will not be possible to ensure that thousands of vulnerable children survive.

Shiza Abbasi is a junior program manager at Ignite Global Health Research Lab at William & Mary, a public research university in Williamsburg, Virginia. Carrie B. Dolan is a spatial epidemiologist, director of Ignite Global Health Research Lab, and an assistant professor of health sciences at William and Mary.