Thousands of public health leaders and clinicians from Africa and the world gathered in Kigali, Rwanda, on December 13-15, for the 2nd International Conference on Public Health (CPHIA) in Africa. The conference theme was “Preparedness for future Pandemic and Post-Pandemic Recovery: Africa at a Crossroad”. A major thread at the conference was the New Public Health Order for Africa which was pioneered by Dr. John Nkegasong, former head of Africa CDC and global ambassador of The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). This new order focuses on building strong African public health institutions, expanded manufacturing of vaccines, diagnostics, and therapeutics, investment in public health workforce and leadership, increased domestic investment in health, and respectful action-oriented partnerships. In alignment with the new public health order, much of the attention focused on communicable diseases such as COVID-19, monkeypox, and the recent Ebola outbreak in Uganda. While I was proud as an African to be part of this much-needed African-led forum on public health in Africa, as an aspiring global surgeon, I was surprised that surgical diseases were excluded from the dialogue despite the fact that 95% of the 1.2 billion people living on the continent do not have access to safe, affordable, and timely surgical care. Robust surgical systems, including the right staff, space, and systems, play a critical role in reducing maternal mortality, childhood deaths, and disability, and even curing sequelae of both communicable and non-communicable diseases. In an astonishing study published in the Lancet, African women are 50 times more likely to die after a cesarean section than women in high-income countries. Globally, conditions amenable to surgical care reportedly kill more people than HIV/AIDS, malaria, and tuberculosis combined, most of them in Africa's low- and middle-income countries. Most of these unjust deaths can be prevented with safer surgical systems. Global health leaders have begun drawing attention to this shocking healthcare problem. Dr. Tedros Adhanom Ghebreyesus, Director General of the World Health Organization, has stated that surgical and anesthesia care is an essential component in achieving Universal Health Coverage and countries must invest in surgery if they are to attain UHC. Some African states such as Rwanda, Ethiopia, Zambia, Nigeria, Madagascar, and Tanzania have begun addressing this problem by developing National Surgical, Obstetric, and Anesthesia Plans. National policies that aim to strengthen national surgical systems. Nonetheless, progress has been slow due to limited financial resources allocated to the implementation of these policies. Efforts from various organisations worldwide, including G4 Alliance, Global Surgery Foundation, and others, have been tabling dialogues around improving access to surgical services through health system strengthening. However, these conversations remain unheard at monumental global public health conferences and gatherings, highlighted when we consider this year’s 2nd International CPHIA. Leave no one behind For far too long, the healthcare agenda and priorities for African countries have been set by foreign institutions and funders, not by African global public health leaders and communities. This is perhaps part of the reason why strengthening surgical systems has not been a healthcare priority on the continent. However, this is changing with initiatives such as the International Conference on Public Health in Africa. As we enter this new era of the New Public Health Order in Africa, we must ensure the inclusion of surgical and anesthesia care in public health dialogues and conferences at both the national and international levels, so that surgical patients are not left behind. Governments should allocate financial resources to sustainable and scalable surgical systems focused on providing quality surgical services and prevention. We need more and better trained surgical and anesthesia providers, nurses, and allied health care providers. We need safer and better-equipped operating rooms and supply chains, access to safe blood, and medicines to prevent deaths and disability from surgical conditions. Furthermore, advocacy groups and media outlets can play a critical role by making the public health dialogue more transparent to the primary stakeholder, the public is aware of movements like the New Public Health Order for Africa by the Africa CDC, the agenda 2063 by the African Union, and the National Surgical Plans. In doing so we can rally people to the global surgery movement that is striving to promote access to equitable and quality healthcare for all. Agenda 2063, ‘The Africa We Want’, which often takes the backseat to the Sustainable Development Goals, is really all about Africans coming together to determine for ourselves what problems we want to solve and how we can work together to do this. I commend the Africa CDC for leading efforts to set continental agendas to achieve Agenda 2063. Nonetheless, to build the Africa we want, the public health agenda setting, and the New Public Health Order for Africa must include surgical care in both local and regional dialogues. Dr. Muhumuza is a physician conducting research and advocating for global surgical systems strengthening. He is a Global Surgery Fellow and part of the Health Policy and Advocacy team at Operation Smile.
