1 VOLUME DISEASE CONTROL PRIORITIES (cid:129) THIRD EDITION Essential Surgery DISEASE CONTROL PRIORITIES (cid:129) THIRD EDITION Series Editors Dean T. Jamison Rachel Nugent Hellen Gelband Susan Horton Prabhat Jha Ramanan Laxminarayan Volumes in the Series Essential Surgery Reproductive, Maternal, Newborn, and Child Health Cancer Mental, Neurological, and Substance Use Disorders Cardiovascular, Respiratory, Renal, and Endocrine Disorders HIV/AIDS, STIs, Tuberculosis, and Malaria Injury Prevention and Environmental Health Child and Adolescent Development Disease Control Priorities: Improving Health and Reducing Poverty DISEASE CONTROL PRIORITIES Budgets constrain choices. Policy analysis helps decision makers achieve the greatest value from limited available resources. In 1993, the World Bank published Disease Control Priorities in Developing Countries (DCP1), an attempt to systematically assess the cost-effectiveness (value for money) of interventions that would address the major sources of disease burden in low- and middle-income countries. The World Bank’s 1993 World Development Report on health drew heavily on DCP1’s findings to conclude that specific interventions against noncommunicable diseases were cost-effective, even in environments in which substantial burdens of infection and undernutrition persisted. DCP2, published in 2006, updated and extended DCP1 in several aspects, including explicit consideration of the implications for health systems of expanded intervention coverage. One way that health systems expand intervention coverage is through selected platforms that deliver interventions that require similar logistics but deliver interventions from different packages of conceptually related interventions, for example, against cardiovascular disease. Platforms often provide a more natural unit for investment than do individual interventions. Analysis of the costs of packages and platforms—and of the health improvements they can generate in given epidemiological environments—can help to guide health system investments and development. The third edition of DCP is being completed. DCP3 differs importantly from DCP1 and DCP2 by extending and consolidating the concepts of platforms and packages and by offering explicit consideration of the financial risk protection objective of health systems. In populations lacking access to health insurance or prepaid care, medical expenses that are high relative to income can be impoverishing. Where incomes are low, seemingly inexpensive medical procedures can have catastrophic financial effects. DCP3 offers an approach to explicitly include financial protection as well as the distribution across income groups of financial and health outcomes resulting from policies (for example, public finance) to increase intervention uptake. The task in all of the DCP volumes has been to combine the available science about interventions implemented in very specific locales and under very specific conditions with informed judgment to reach reasonable conclusions about the impact of intervention mixes in diverse environments. DCP3 ’s broad aim is to delineate essential intervention packages and their related delivery platforms to assist decision makers in allocating often tightly constrained budgets so that health system objectives are maximally achieved. DCP3 ’s nine volumes are being published in 2015 and 2016 in an environment in which serious discussion continues about quantifying the sustainable development goal (SDG) for health. DCP3 ’s analyses are well-placed to assist in choosing the means to attain the health SDG and assessing the related costs. Only when these volumes, and the analytic efforts on which they are based, are completed will we be able to explore SDG-related and other broad policy conclusions and generalizations. The final DCP3 volume will report those conclusions. Each individual volume will provide valuable specific policy analyses on the full range of interventions, packages, and policies relevant to its health topic. More than 500 individuals and multiple institutions have contributed to DCP3. We convey our acknowledgments elsewhere in this volume. Here we express our particular gratitude to the Bill & Melinda Gates Foundation for its sustained financial support, to the InterAcademy Medical Panel (and its U.S. affiliate, the Institute of Medicine of the National Academy of Sciences), and to the External and Corporate Relations Publishing and Knowledge division of the World Bank. Each played a critical role in this effort. Dean T. Jamison Rachel Nugent Hellen Gelband Susan Horton Prabhat Jha Ramanan Laxminarayan 1 VOLUME DISEASE CONTROL PRIORITIES (cid:129) THIRD EDITION Essential Surgery EDITORS Haile T. Debas Peter Donkor Atul Gawande Dean T. Jamison Margaret E. Kruk Charles N. Mock © 2015 International Bank for Reconstruction and Development / The World Bank 1818 H Street NW, Washington, DC 20433 Telephone: 202-473-1000; Internet: www.worldbank.org Some rights reserved 1 2 3 4 18 17 16 15 This work is a product of the staff of The World Bank with external contributions. 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All queries on rights and licenses should be addressed to the Publishing and Knowledge Division, The World Bank, 1818 H Street NW, Washington, DC 20433, USA; fax: 202-522-2625; e-mail: [email protected]. ISBN (paper): 978-1-4648-0346-8 ISBN (electronic): 978-1-4648-0367-3 DOI: 10.1596/978-1-4648-0346-8 Cover photo: The 16 Makara hospital in Cambodia’s remote Preah Vihear province is equipped with modern equipment. The maintenance of 16 Makara is supported by the World Bank and other international donors through the Health Sector Support Program and the Cambodia Second Health Sector Support Program. Photo: © Chhor Sokunthea/World Bank. Further permission required for reuse. Cover and interior design: Debra Naylor, Naylor Design, Washington, DC Library of Congress Cataloging-in-Publication Data Essential surgery / volume editors, Haile T. Debas, Peter Donkor, Atul Gawande, Dean T. Jamison, Margaret E. Kruk, Charles N. Mock. p ; cm. — (Disease control priorities ; v. 1) Previously published in: Disease control priorities in developing countries, 2nd ed. c2006. ISBN 978-1-4648-0346-8 (v. 1 : pb) — ISBN 978-1-4648-0097-9 (v. 1 : hc) I. Debas, Haile T., editor. II. Disease control priorities in developing countries. III. Series: Disease control priorities ; v. 1. [DNLM: 1. General Surgery—economics. 2. Developing Countries. WA 395] RD27.42 362.197—dc23 2014037594