1. Lancet Commission in Global Surgery June 2014

2. Parliament of Sierra Leone

3. Lancet Commission in Global Surgery House of Parliament Session # 1 June 2014

4. Resolutions Key messages Metrics Recommendations Future Research Requirements for safe surgery

5. Terms of Reference You will need your smartphone or computer If you have neither with you – Katie will get you some paper Use your subject line for the title of the resolution You may vote up or down on a resolution or change/edit it in your vote You may also use your own ideas “Vote early and often” You may NOT vote to impeach the commission chairs

6. Key Messages What is a Key Message? eg: GH2035 Let’s get started: – Pull up a new email message – jmeara@pih.org jmeara@pih.org – Type “Key Messages” in subject line – You may vote for ONLY 3 (THREE) key messages – You may make up your own messages – Or, mix and match

7. Key Messages (type “Key Messages” in subject line) 1.Rights/equity (Farmer resolution): 5 billion people do not have access to safe affordable surgical and anesthesia care when needed 2.Structure/process (Jim Kim resolution): Surgery is an indivisible, indispensible component of a properly functioning health system 3.Governance/management (Eva Hanciles resolution): Huge gains in surgical care provision are possible with already existing health care systems by employing proper governance and management principles and training processes 4.Economic (Yamey/Conteh/Yip resolution): Investments in surgery are pro growth, cost effective, have a positive ROI etc…

8. Metrics (yes or no on all) 1.Proximity: Percent of population within 2 hours to a facility capable of safe emergency surgery 2.Timeliness: Emergency surgery performed within 24 hours 3.Workforce: Trained providers per population 4.Throughput: Procedure rate per population 5.Elective to emergency procedure ratio 6.Capacity: Percent of district-level hospitals meeting requirements for safe surgery 7.Outcomes: Peri-Operative Mortality Rate (all procedures or bellwether) 8.Financial Protection: Percent of population falling into poverty or incurring catastrophic expenditure due to out-of-pocket healthcare expenditure * 9.Mixed: Unmet need for surgical care 10.Strategic Planning: Inclusion of surgery within national or regional health plans

9. Recommendations Your own ideas 3 and ONLY THREE Be as specific as possible Direct it to a specific stakeholder if appropriate

10. Recommendations - Stakeholders Govts/MOH/MOF WHO WBG USAID Foundations – Clinton/Gates NGOs Academic medical centers – HIC or LMICS Colleges and professional societies – HIC or LMICS Industry Patients

11. Future Research Agenda Choose 3 on your own What are the 3 most important things in which to invest research resources in the next 5-10 years? Potential categories – Access – Burden – Quality – Safety – Workforce – Implementation – Benchmarking – Cost of care delivery – Barriers to access/care – Patient experience

12. Requirements for Safe Surgery yes or no on all 1.Staff: A trained surgical provider and team 2.Staff: A trained anesthesia provider and team 3.Staff: Postop nursing care, and physiological observations 4.Staff: 24/7 surgical cover to review & assess patients 5.Stuff: Equipment, supplies, consumables, antibiotics and pain meds 6.Stuff: Equipment maintenance 7.Stuff: Sterilization capability 8.Stuff: Screened and cross-matched blood 9.Stuff/Staff protection: Gloves, and the ability to test for HIV 10.Process: Safe surgery checklist * 11.Process: Preoperative risk assessment and operation planning