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New Social Compact

To Realize Universal Health Coverage, Surgical NGOs Must Play a Crucial Role

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Authors: John L. Dutton, Desmond T. Jumbam and Libby Bunker

The COVID-19 pandemic has eroded and exposed fragile health systems globally.

Health care workers have been overwhelmed by the sheer numbers of patients needing intensive care, which has devoured already limited resources, stretched tenuous supply chains and spread thin the efforts of those one the front lines.

Sadly, essential surgical services, including live-saving surgeries to repair cleft lip and cleft palate, cesarean sections and many more, which were already in strikingly short supply, especially in low- and middle-income countries, have been made worse by the pandemic.

Much progress and change need to be made so that reactive health care systems can become proactive in the face of crises. That paradigm shift is also essential if we are to achieve the U.N.’s lofty goals for universal health coverage – access to the health services that all people need, when and where they need it without experiencing financial hardship – by 2030.

Surgical nongovernmental organizations (NGOs) must play a key role in achieving these goals.

COVID-19 has directly led to significant disruptions in surgical care. Data from 112 countries shows that half of these countries are providing 70% less surgeries than before the pandemic with the greatest reduction in low-income countries. Most of these interruptions have been justified, as evidence from The Lancet has shown that half of patients who become infected COVID-19 before or after surgery develop pulmonary complications and are more likely to die after an operation.

Prior to the pandemic, more than 100 million additional surgical procedures were needed annually in low- and middle-income countries. Current surgical delays exacerbate this unmet need: Even more mothers needing cesarean sections due to obstructed labor, more children needing their appendix removed due to infection, and more people requiring trauma surgery to repair severely fractured bones are without access to life-saving procedures.

Tragically, these and millions of others are at risk of death or disability because health systems lack adequate infrastructure and skilled health workers to address the surgical needs of their people. 

In the past, investing in surgical systems – from equipment to supplies to training more skilled health workers and operating rooms – were thought to be too expensive, too complex or too daunting. However, many essential surgeries are among the most cost-effective health services as highlighted by the World Bank’s Disease Control Priorities, Vol. 3. 

Moreover, as shown by the Lancet Commission on Global Surgery, we now know that reliable surgical infrastructure can strengthen an entire health system, promote economic productivity, and help hospitals weather unexpected shocks like COVID-19.

Unfortunately, in countries where those investments are most needed, progress has been slow.

In 2015, the World Health Assembly (WHA) unanimously passed resolution 68.15 and, for the first time, recognized emergency and essential surgical care and anesthesia as an integral part of universal health coverage. Dr. Tedros Adhanom Ghebreyesus, Director General of the World Health Organization (WHO) stated that “no country can achieve universal health coverage unless its people have access to safe, timely and affordable surgical services.”

Several countries including Tanzania, Zambia, Pakistan, Ethiopia and others are developing and implementing National Surgical Obstetric and Anesthesia Plans (NSOAPs), national policies for improving a country’s surgical system for the long term, to begin implementing the WHA resolution at the country level.

Despite these meaningful efforts, WHA resolution 68.15 and NSOAPs have yet to transition from policy into action in a meaningful and sustainable manner.

Surgical NGOs, with their direct links to communities and policy makers, are well-positioned to enact these policies. They can and must take a leading position in bringing these plans to fruition.

Working alongside local stakeholders, surgical NGOs will need to expand their services to include infrastructure development for hospitals, increasing research capacity and training local surgical providers. This approach strengthens overall health systems rather than solely focusing on surgeries for a specific patient population.

Some notable examples include KidsOR, which has been able to outfit 25 pediatric operating rooms in 11 countries; LifeBox, which has provided more than 22,000 pulse oximeters to over 100 countries; and Jhpiego, an organization that has trained over 275,000 health care workers globally.

Recognizing the broad social reach that surgical NGOs seek to have, it is important for them to align their services with the health needs and priorities of international governments as outlined in those countries’ NSOAPs.

Operation Smile, a surgical NGO with four decades of experience providing comprehensive cleft care to children around the world, is doing exactly this. Through projects such as the ongoing Global Essential Surgery Project, funded by the UBS Optimus Foundation, Operation Smile is improving surgical systems at hospitals in Nicaragua, Madagascar and Vietnam in collaboration with ministries of health and front-line providers.

To date, the project has trained more than 1,000 health care workers, constructed new operating rooms, implemented safe surgical protocols, trained local biomedical technicians, and engaged local communities so that their residents are aware of conditions that can be treated by surgeries offered at those hospitals.

Early results are promising: Both the number of surgical patients admitted and the number of surgeries provided within the project’s partner hospitals have increased by more than 60% since 2018. More patients are seeking care, and hospitals possess an increased ability to meet this new demand.

Importantly, the evidence generated through this project will help bridge the gap between policy and practice.

Here is our advice for surgical NGOs as they expand their roles towards universal health coverage:

·       Establish equitable partnerships by equipping local health care workers with the knowledge and training necessary to provide care for the long term, drive economic progress and decrease dependency while recognizing that these efforts will take time.

·       Employ a broadened approach that allows for more patients to receive the care they need while simultaneously investing in surgical systems for more ongoing and sustainable care.

·       Expand funding sources by seeking additional avenues of funding. Social impact investors are ready to support sustainable programs that are measurable, repeatable and scalable.

·       Collaboration with other surgical NGOs is critical and must be performed in a transparent manner. Competition will sequester results; collaboration will achieve them

·       Data is vital for establishing evidence needed for scaling up impactful programs and implementing health policies. Improved data tracking processes can be integrated into local and national practices to strengthen information management systems.

·       Partnering with policy makers is paramount. Universal health coverage cannot be achieved without the collaboration of ministries of health.

As we’ve passed the one-year mark since the first cases of COVID-19 and reflect on a pandemic that has so drastically changed our daily lives, we must look onward to how we will repair the flawed health systems and social inequalities that this virus has exposed.

Moving forward, surgical NGOs must act as catalysts that provide activism, partnership and leadership to drive fundamental change – change that ensures universal access to safe, timely and effective surgical care for health that lasts – no matter where you live or how much money you have. 

John Dutton, MD serves as a Global Surgery Fellow at Operation Smile. He is a graduate of Franklin & Marshall College.

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New Social Compact

The Death News of Sidharth Shukla: In the remembrance of Sidnaaz

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For most individuals, the death news of Sidharth Shukla seems implausible. Sidharth Shukla, popular actor, and 13 winner Bigg Boss died on Thursday 2 September suffering a severe cardiac arrest at Cooper Hospital in Mumbai.  Actor Sidharth constantly challenged the odds in his profession. For many in the TV and movie sector, it is a last-ditch and sometimes fruitless effort to stop a slide into irrelevance in the popular reality program Bigg Boss. But Shukla was the household name that became a feather reality TV sensation for himself who won the 13th show edition in 2019. For the first time, Shukla entered the television limelight, working on BalikaVadhu (2012), in which he tried the part of District Collector Shivraj Shekhar. Shukla portrayed the character throughout the space of three years and won several accolades. A few whiles later, in Humpty Sharma Ki Dulhania (2014), he was reputed to a costar, once again receiving acclaim. Born and reared up in Mumbai, Shukla began as a model by taking a position as a leader in the Manhunt and Mega model Gladrags contests and then starred in Bajaj and ICICI Banking television commercial campaigns. Shortly thereafter, he premiered on Babul Ka Aangann Chootey Na, followed by a range of dramatic TV shows such as CID and Aahat, which include criminal dramas. In 2016 Khatron Ke Khiladi won Fear Factor as well. Shukla has also been a popular television host with such series as Savdhaan India and the Got Talent 6 of India. His death caused a shock to the television and film industries.

Police authorities in Mumbai claimed that at around 9 a.m. before death, Shukla complained about cardiac pressure in his home in Oshivara, Mumbai.  At that time, his sister, his mother, and brother-in-law were in the house. A physician who came to the house found that he was pulseless. “The family went to Dr. RN Cooper hospital and requested an ambulance. They reached about 9.45 am and before admission he had been proclaimed dead.” The Forensic department leader, Dr. R Sukhdev, verified that on Thursday morning, Shukla was brought dead. The afternoon postmortem exam was performed. No external damage on his body was detected before the autopsy by physicians and police. The Dean of Dr. RN Cooper Hospital, Dr. Sailesh Mohite, refused to comment on the autopsy findings.

Many Celebertities Condolences

“Siddharth, gone too soon. You’ll be missed…” said Actor Salman Khan, who gave him the trophy of Bigg Boss. Kapil Sharma TV comedy host tweeted, “Oh god, it is truly shocking, my condolences to the family, and prayers for the the departed soul” Several TV and film fraternity members, like Rajkummar Rao, came to Mumbai to pay their final honors in Shukla Residence. On Friday his last rites will be conducted.

Shehnaaz Gill on Sidharth Shukla death

Sources close to the actor and individuals who went to his house and told Sidharth Shukla’s family that Shehnaaz is in a condition of shock and cannot cope with his loss today. Source further stated Shehnaaz was deeply impacted by the untimely death of the Balika Vadhu actor. Shehnaaz was very near to Sidharth, and she frequently publicly demonstrated her affection for him. Her compassion and caring for him never shied away. She said she was even in love with him openly. Fans liked their duo much after BB 13, and invented their moniker with affection, Sidnaaz. In two recent programs, Back-to-Back Bigg Boss OTT and Dances Deewane 3, the reported couple had featured.

Sidharth Shukla breathed his last in Shehnaaz Gill’s arms

Sidharth was still complaining of discomfort, and Shehnaaz and his mother begged him to relax. Sidharth was unable to sleep, on the other hand; thus Shehnaaz was requested to remain with him and pat on his back. Sidharth lay on the lap of Shehnhaaz at 1:00 a.m., and the latter walked away gently. She slept, too, and when she woke up at 7am, she found Sidharth sleeping in the same position without moving, and he didn’t stir when she tried to wake him up. From the 12th story to the fifth level, where his family resided, Shehnaaz was terrified and hurried. She notified Sidharth’s sister and phoned their doctor of the family, who told Sidharth that he hadn’t been there anymore.

Ye ‘Dil’ hai Muskil

Why are young people suffering from heart attacks? The death of Siddharth Shukla, 40 years old, has stunned everyone. Initial stories indicating that a heart attack is the reason for Thursday’s death were killed, along with the big boss winner Season-13. In recent times, heart disease has been a worry for health professionals among young Indian people. The question is why in very young age groups in India there has been an increase in cardiac attack.

Concluding Remarks

The greatest way I can escape the trap of thinking that you have anything to lose is to remember that you will die. No excuse to not follow your heart. Nobody wants to die. Nobody wants to die. Such people don’t even want to die to go to paradise to get there. And yet death is our common destination. Nobody has ever avoided it and this is why death is perhaps the finest invention of existence. Life is the agent of transformation. The old one is clearing way for the new one.

Death is, however tragic, probably God’s most beautiful creation. Death is merely another trip; birth and life will never take place without death. It’s unavoidable to lose somebody. Bill Watterson, the creator of Calvin and Hobbes, illustrates this wonders: Death is transitory and the meaning of life and death. Death is temporary. Death is a normal part of life, we have to realize. Death gives life its full significance. Let life be like summer flowers, let life be lovely and death be like fall leaves. But would it not be much easier to face our own mortality, rather than being unhappy, knowing that our life has been fully and without regret? Even if we don’t want to go to die, it’s just as unavoidable for the sun at night. In conclusion, when your time comes, you don’t have to die happy but you need to die satisfied, since from start to finish you have lived your life.

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New Social Compact

4.1 billion lack social safety net

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More than four billion people live without any welfare protection today to cushion them from crisis, the UN International Labour Organization (ILO) said on Wednesday, while highlighting how the COVID-19 crisis has pushed up government spending by some 30 per cent.

Leading the call for countries to extend social safety nets far more widely than they do now, ILO Director-General Guy Ryder insisted that such a move would help future-proof workers and businesses in the face of new challenges.

“This is a pivotal moment to harness the pandemic response to build a new generation of rights-based social protection systems,” said Mr. Ryder.

“These can cushion people from future crises and give workers and businesses the security to tackle the multiple transitions ahead with confidence and with hope. We must recognize that effective and comprehensive social protection is not just essential for social justice and decent work but for creating a sustainable and resilient future too.”

In a new report the UN body acknowledged that the COVID-19 crisis had led to greater social protections worldwide, albeit mainly in wealthy countries.

It noted that only 47 per cent of the global population are covered by at least one social protection benefit, while only one in four children has access to national welfare safety nets.

Newborns’ needs unmet

Further research indicated that only 45 per cent of women with newborns worldwide receive a cash benefit, while only one in three people with severe disabilities receive a disability benefit.

Coverage of unemployment benefits is even lower, ILO said, with only 18.6 per cent of jobless workers effectively covered globally.

On retirement welfare, the UN body found that although nearly eight in 10 people receive some form of pension, major disparities remain across regions, between rural and urban areas and women and men.

Regional imbalances

The ILO report underscores the significant regional inequalities in social protection.

Europe and Central Asia have the highest rates of coverage, with 84 per cent of people having access to at least one benefit.

Countries in the Americas are also above the global average (64.3 per cent), in stark contrast to welfare roll-out in Asia and the Pacific (44 per cent), the Arab States (40 per cent) and Africa (17.4 per cent).

Highlighting differences in government spending on social protection, ILO said that high-income countries spend 16.4 per cent of national turnover (above the 13 per cent global average, excluding health), while low-income countries budget just 1.1 per cent.

Billions more needed

The UN body noted that since the start of the COVID-19 pandemic, governments have had to increase spending massively to ensure minimum social protection for all, by around 30 per cent.

And it maintained that to guarantee basic social protection coverage, low-income countries would need to invest an additional $77.9 billion per year, lower-middle-income countries an additional $362.9 billion and upper-middle-income countries a further $750.8 billion annually. That’s equivalent to 15.9 per cent, 5.1 per cent and 3.1 per cent of their GDP, respectively.

“There is an enormous push for countries to move to fiscal consolidation, after the massive public expenditure of their crisis response measures, but it would be seriously damaging to cut back on social protection; investment is required here and now,” said Shahra Razavi, Director, ILO Social Protection Department.

Underscoring the multiple benefits of social welfare protection, Ms. Razavi insisted that it could promoted “better health and education, greater equality, more sustainable economic systems, better managed migration and the observance of core rights…The benefits of success will reach beyond national borders to benefit us all”.

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New Social Compact

Hell for Women?

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35-years-old woman and her daughter were raped by rickshaw driver and his accomplice in Lahore; On independence day of Pakistan, a TikToker was sexually harassed in Lahore; woman on rickshaw was harassed publically in Lahore and people were cheering; Noor Mukadam, daughter of a Diplomat, was brutally bumped off in Islamabad; a female school teacher was raped by owner of the school; a minor girl was raped by principal of seminary; a woman was gang raped by robbers in front of her family in Sheikhupura; a man with his three friends gang raped his fiancée and snatched jewelry; 16-years-old girl was raped by her stepfather in Lahore; mother of four children was raped in Bhagatpura; a 10-years-old was raped in Manwan; 17-years-old girl was raped after being promised a job; a minor girl was raped and sent to cemetery in Korangi; a woman was abducted and gang raped; an elderly woman was tortured, dragged and attempted to rape. Few cases have been quoted here. Sorrowfully, numerous other cases are remaining to be mentioned here. Unfortunately, a tiny figure of cases have been reported, still beaucoup cases are unreported.

Given obnoxious incidents give women sense of insecurity and uncertainty. Wretchedly, women in our society are deemed as prey and an open invitation by mad dogs (rapists) which they cannot evade and leave no stone unturned to assault them. The exponential rise in gender-based violence has proselytized our society into a hell for women, where they are considered as inferior segment of the society. This abysmal picture of our society adversely impacts our international image.

 The study conducted by Georgetown Institute for Women, Peace and Security, despite improving in women’s perception of community safety, still ranks Pakistan fourth among the worst countries for women to live in.

In accordance with the official data- collected from law enforcement agencies and human rights commission of Pakistan- at least 11 rape cases are reported regularly in Pakistan. More, the last six years data unearthed an icky tally of 22,000 cases registered to police in Pakistan. Dolefully, the conviction rate stood at 0.3% of total figure. 

Research conducted by Geo News revealed that only 41 per cent of cases have been reported to the Police. A police official estimated the actual number could be as high as 60,000 in last five years.

Furthermore, the Cyber Wing of the FIA in Lahore told that they have received 6,168 sexual harassment complaints out of total 14,108 in less than eight months. It further explained that mostly the complaints were lodged by University and College students relating to blackmailing by peers through the use of doctored videos and photographs.

Regarding violence against women, Punjab made up to 73 per cent of total cases, Ministry of Human Rights Toll-free helpline data showed. Besides, recent data by Punjab police divulged 1,890 rape cases and 88 gang-rape cases have been registered just in first six months of this year.

The reasons behind alarming rise in rape cases, which are mostly opined and observed personally, are rivalries, perpetrators remain scot-free, and incompetency of police.

In rivalries, various women have been raped because perpetrators think that it is better mean to smirch antagonist and avenge. As of the June of this year, when a boy tied love knot with daughter of an influential person, in avenge his mother 50-years-old was kidnapped, tortured, dragged, burned half-naked body with cigarette butts and attempted to rape by that influential people in Mazaffargarh. Exclusively, in village sides, women are raped in compensation, if victim’s father, brother or guardian has raped any girl.

Besides, since 2015, more than 22,000 cases of harassment have been registered to police, more than 4000 cases are still pending in the courts and only 18 per cent cases have managed to reach prosecution. Backlog of cases, takes too much time to provide justice to women and deter others to execute same. Thereby, executors remain unpunished and rape another woman with impunity. In some cases, rapists are granted pre-arrest bails. Afterwards, they threaten victim and her family to withdraw case; which fingers out the competency and justice of honorable courts and provides free space to those rapists to continue harassing women.

Apart from this, various cases are not reported due to family or social pressure, because they have to undergo another victimization. Karachi-based organization, War Against Rape (WAR), exposed that women who report the crime are coerced to visit male-dominated police stations and asked unnecessary questions that is why people remain silent and do not register complaints to shun answering gratuitous questions, which creates obstacle in the way of justice by sparing space to rapists.

Apart, victim blaming also desists victim to register complaint. Victim’s character is questioned, she is blamed for the rape and some misogynists and advocates of patriarchal society put allegations on victim giving illogical reasons. In consequence, victim find it easy to be silent rather than being pilloried countrywide and does not register her complaint, which indirectly paves the way for rapists to feel free from being brought to book and harass women whenever and wherever they want.

To counter this evil, Punjab Police has launched a safety App that will enable women to contact police through a message and it will enable Police to trace location of complainants through smart phones. Senior Police official assured that App will be launched in all districts of Punjab soon and a special squad will be formed soon in this regard. This initiative is praiseworthy and can be fruitful, if cooperated. All women should download this App so that in any emergency they can contact Police easily.

Additionally, separate courts for rape cases should be operational as soon as possible in order to evade years of pending cases. More medico-legal officers should be appointed to speed up medical process. Police should enforce all anti-harassment, anti-rape and anti-crimes against women laws and all women should be acquainted to these laws so that they can report crimes easily and immediately.

To sum up, society will remain hell for women, until our society is patriarchal and culprits remain scot-free. No society can be stable and prosperous, if women of that society are not secure and honored by every individual. If mentioned laws are implemented effectively, women of our society can live respectfully and society can be a heaven for them.

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