The collateral damage of the COVID-19 pandemic on surgical healthcare in sub-Saharan Africa

The COVID-19 (C19) pandemic has swept across the globe at an unprecedented pace. The first C19 case arrived in Sub-Saharan Africa (SSA) on February 28, 2020, and there are over 600,000 cases spread across the continent [1]. The World Health Organization has predicted up to a quarter of a billion infections on the continent [2]. In preparation, SSA countries have sharply down-scaled non-C19 health services, including emergency and essential surgical healthcare (EESC). However, surgical conditions contribute up to a third of the global burden of disease [3]. Surgical healthcare services are therefore essential to address common conditions that affect mothers, children and adults throughout their lifespan; yet most people in the world (an estimated 5 billion) cannot access such essential care. Scaling down EESC in SSA is likely to have significant and enduring health consequences for the region. Surgery is a vital component of healthcare services needed to achieve the health priorities in SSA. Several of these priorities are articulated in the Sustainable Development Goals (SDGs) and regional intergovernmental entities [4], and include maternal and child health, injuries and non-communicable diseases. With recent estimates suggesting that postoperative deaths are the third-highest cause of death, globally [5], quality is a significant consideration[6], in addition to expanding access in SSA. However, women are 50 times more likely to die from caesarian sections in SSA compared to their counterparts in high-income countries [7]. Expanding access, in addition to improving the quality of surgical care is, therefore, a requisite for SSA nations to attain health targets in maternal and child health, cancer, injuries and universal health coverage. Before C19, SSA nations were amongst the countries with the most limited access to surgical healthcare globally [3]; with hindsight, the current pandemic preparedness could very well be the “straw that broke the camel’s back”, requiring a much harder restart, more significant investment, time and commitment. Safe, timely, and affordable surgical healthcare is considered a core element of health service delivery, with significant benefits for broader economic growth and sustainable development in SSA [8]. In this paper, we discuss how health system changes due to C19, in particular the preparedness response, are increasing the barriers to EESC in SSA.