The recent efforts to introduce a WHA resolution recognizing the importance of surgery and anesthesia in global health were started in about 2009. Those efforts focused on increasing awareness of this issue; soliciting input on the nature of such a resolution - particularly from surgeons in low and middle income countries; and gathering letters of support and endorsement from surgical and anesthesia societies, academic medical centers, and non-profit organizations. In 2013, attention was focused on the countries comprising the WHA Executive Board (EB) with the hopes that one or more would formally propose the surgical care resolution.
In January 2014, the WHA EB met to finalize the agenda for the 67thWorld Health Assembly in May 2014. The themes relevant to surgical care at this meeting include non-communicable diseases (EB 7.1); disability (7.3); health related Millennium Development Goals (MDGs) and health in the post-2105 UN Development agenda (8.1); violence, particularly against women and girls (8.4); health systems (9) and universal health coverage (9.6 and 9.8).
At the January meeting, the importance of surgical care was emphasized for at least two agenda items. Dr. Emmanuel Makasa of Zambia made a formal statement during the discussion on the Disability agenda item (7.3) with regard to “’tabling a resolution in this house (in the near future) together with other member states that aims at strengthening Essential and Emergency Surgical Care at the primary level of healthcare as a way of preventing disabilities arising from road traffic accidents and other domestic and industrial injuries.” Another statement was made from Senegal on the need to consider surgical care during the Health Interventions and Technology agenda item (9.6).
At the close of the January EB meeting, a representative from Senegal requested that the topic of surgical care be placed on the agenda for the next meeting of the EB (May 26-7 immediately following the WHA meeting). This request was approved and the surgical care topic was accepted for inclusion on the upcoming agenda. Of note, the May EB meeting establishes the themes for discussion at the WHA for the following year.
During the week long May 2014 WHA proceedings there were two related events to raise awareness of the importance of surgical care on the global public health agenda. The side meeting on ‘Improving Safe Emergency and Essential Surgical Care and Anaesthesia’, held at the Palais des Nations, attracting more than 200 attendees. A panel of speakers included Ministers of Health from Zambia, Nigeria, and Rwanda and speakers designated by the Ministries of Health of Australia, USA, Timor-Leste and Egypt. Each of the four NGOs in official relations with WHO: the International College of Surgeons (ICS), International Federation of Surgical Colleges (IFSC), International Society of Orthopaedic Surgery and Traumatology (SICOT), and World Federation Societies of Anaesthesiologists (WFSA) made formal statements. Further comments were heard from delegations representing the ministries of health of over 45 member states.
Later that evening, a well attended “Reception for Global Surgery and Anaesthesia Partners” was held at the InterContinental Hotel which gave attendees, including official WHA delegates as well as representatives from civil society, additional opportunity to discuss the importance of surgical care. Ambassador Jimmy Kolker of the US Office of Global Affairs made a formal statement of support, and additional statements were heard from the WFSA, ICS, IFSC, and the International Federation of Medical Student Associations (IMFSA). Sponsors of the reception included Gradian Health Systems, the Henry Family Foundation, Operation Smile, and the Johns Hopkins global surgical team.
On May 26, 2014 the WHA Executive Board unanimously passed the EB agenda item “Strengthening Emergency and Essential Surgical Care and Anaesthesia as a Component of Universal Health Coverage”. This topic then became part of the formal agenda for 2014-2015. Per Dr. Meena Cherian, Director of the WHO’s Emergency & Essential Surgical Care (EESC) program at that time, “over 30 Member States and 6 NGOs, the Assistant Director General, and the Director General voiced their support of the EB Agenda Item." (Summary of Statements)
On January 29, 2015, the World Health Assembly Executive Board unanimously passed Agenda Item 10.1, “Strengthening Emergency and Essential Surgical Care and Anaesthesia as a Component of Universal Health Coverage”, with no amendments. 28 countries and 6 NGOs made formal statements of support.
The resolution can be read as presented – http://apps.who.int/gb/ebwha/pdf_files/EB136/B136_R7-en.pdf.
On May 22, 2015, World Health Organization Resolution 68.15 was unanimously ratified at the 69th World Health Assembly.