Improving equitable access to surgical care around the globe

Creating a sustainable impact on global health has been an integral part of Proximie’s DNA from the very beginning and no more so than in 2023.

We're facing an unprecedented crisis in surgery, with challenges affecting workforce shortages, system-level productivity, patient safety and surgical quality. Approximately five billion people lack access to safe surgery and 143 million additional surgical procedures are needed in low and middle income countries (LMICs) each year to save lives and prevent disability (1). The provision of surgical healthcare is suboptimal for patients in most low-income and middle-income countries (LMICs), where there are substantial disparities in equity, sustainability, effectiveness, efficiency and responsiveness of the care provided. Only 6% of surgical procedures occur in the poorest countries, where one-third of the world’s population resides (2). To add further complexity to this widening disparity, there is an estimated shortfall of 10 million health workers by 2030, mostly in LMICs (3).

Fundamentally, health systems can only function with health workers; improving health service coverage and realising the right to access the highest attainable standard of health is dependent on the availability, accessibility and quality of staff. A new model needs to be established, both now and in the future, that is founded on the principles of equal distribution, sustainable delivery, dynamic scalability and robust cost efficiency.

Creating a sustainable impact on global health has been an integral part of Proximie’s DNA from the very beginning and has been a fundamental aim throughout 2023. Our dynamic approach to private-public partnerships, with organisations like Saving Mothers, a nonprofit improving the quality of maternal healthcare worldwide, and standardising care for Obstetric Safe Surgery in Makueni County, Kenya, with Jhpiego and the County Department of Health (DOH), ensures surgical support and training is available virtually whenever needed. These partnerships are not drop and run endeavours either. They require locally owned partnerships, consistent structured data collection, co-creation driven by local champions and ultimately, robust change management that equips health systems for sustainable, long term integration and use.

“Creating a sustainable impact on global health has been an integral part of Proximie’s DNA from the very beginning and has been a fundamental aim throughout 2023.”

Global Head of Health at Proximie, Dr. Shannon Shibata-Germanos, explains: “We become long-term partners as the field evolves and as a company we have understood the importance of considering and shaping blended healthcare environments together with our collaborators to ensure the technology has staying power. We recognize that the "human touch" is paramount in healthcare; however, technology can augment, enhance and drive remarkable efficiency gains in health systems - and such efficiencies in a world where there is an unparalleled health workforce shortage are priceless.”

“We recognize that the "human touch" is paramount in healthcare; however, technology can augment, enhance and drive remarkable efficiency gains in health systems…”

Proximie’s work in the Global Health sector is never passive. In the last month, Proximie has showcased important successes to date in Makueni County at Kenya Innovation Week 2023. The event helped to highlight the collaborative partnership between Proximie and Makueni County Governorate and to demonstrate the success of integrating our platform into their healthcare system to ultimately help to digitise ORs across the county, which serves a population of over one million people.

During the event, Daniel Nzau, a Surgical Theatre Nurse for Obstetrics and Gynecology, representing the Makueni County Government and Proximie, remotely dialled into a live emergency caesarean section, highlighting Proximie's power to ensure surgical care is available virtually, and whenever needed. Daniel dialled into the emergency caesarean section using just his mobile phone.

As Proximie continues to scale in Kenya to counties including Makueni, Nakuru, Mombasa and Nairobi, and expand to surgical specialties including Obstetrics, Neurosurgery, Laparoscopy, Orthopedics, Vascular and Eye Surgery, #KIW2023 was an exhilarating moment to take stock of the vibrant and innovative healthcare community in the region. A community of innovators that are driving Kenya’s Digital Health policy forwards towards reaching Universal Health Coverage.

Improving access to safe surgical care is fundamental to the attainment of the UN Sustainable Development Goal 3: Ensure healthy lives and promote well-being for all at all ages and for the specific targets within it (4). Yet global health systems are responsible for 4.4% of total next global emissions from fossil fuel combustion, compared with 2.5% from aviation. If health systems were a country they would be the fifth largest emitter of greenhouse gases. Surgical practice is also one of the biggest single causes of health system resource use (5). Creating sustainable models of healthcare delivery should be an aspiration everywhere, not just somewhere and not for the distant future, but now.

“Creating sustainable models of healthcare delivery should be an aspiration everywhere, not just somewhere and not for the distant future, but now.”

Proximie’s partnerships in the Global Health sector - using our cloud-based software that is evolving the analogue environment of the operating room into data-driven, digitally-connected ecosystems - are the blueprint for future healthcare delivery. They are helping to provide high quality and sustainable training and in-service education for health workers so they can deliver high quality care, the first time, every time.

Dr. Doris Nthenya Mbithi, Medical Superintendent of the Mother and Child Hospital in Makueni County and a partner in the Jhpiego Obstetric Safe Surgery Program (OSS), explains: “One of the challenges encountered during in-person mentorship visits was that after travelling sometimes long distances you could never predict if there would be a scheduled case. This is no longer an issue since the introduction of Proximie being layered into the powerful OSS Program. I can now scrub in-virtually anytime from anywhere and work with the team with greater consistency and frequency which is critical in mentorship and upskilling. There is now the opportunity to share best practices regularly at our convenience and build upon in-person mentorship with greater efficiency.”

“There is now the opportunity to share best practices regularly at our convenience and build upon in-person mentorship with greater efficiency.”

Digital technology has a crucial role to play in bridging the gap between historically siloed sectors to leverage comparative advantages and high-value expertise towards future-proofing health systems globally. Shared knowledge is the catalyst for progress and by capturing every single interaction in an operating room in meticulous detail, we can help to unlock an abundance of insights and data that can ultimately shape the frontiers of healthcare today, and in the future. It also enables asynchronous review and the capacity to spot-check and audit cases to identify and close large quality improvement gaps.

Universal health coverage cannot be achieved without ensuring that surgical care is truly accessible, sustainable and safe for all. To truly democratise access to safe surgery, and support the growth of a healthy surgical workforce, we need to create models of high-quality and high-value surgical care and upskilling in a way that is environmentally, socially, and financially sustainable. For everyone.

Dr. Kamill Marie Frías Ureña, a GP currently studying for her residency at La Maternidad, in the Dominican Republic, where Proximie has partnered with Saving Mothers, explains: “I’ve seen how being able to use Proximie and receive remote assistance has really motivated the residents. They are able to dedicate a lot more study time to the questions they’re being asked, and now that we’re recording all the sessions they are able to go back and see everything that was done during a procedure. We have a practice surgery box so they are able to review the recordings and then practise those procedures in the box. It has been amazing to see how much they enjoy and benefit from doing that, and whenever they have questions for specialists it is now so much easier to ask them via Proximie.

"I hope Proximie gets implemented in every public hospital so that we can bring together surgical expertise from all over the world to share knowledge, so that we can give women better access to healthcare that they might not otherwise have."

"I hope Proximie gets implemented in every public hospital so that we can bring together surgical expertise from all over the world…”

Dr. Shannon adds: “Our mission through our Global Health efforts, has always been to make Proximie a best-in-class digital platform accessible to everyone, no matter where they live, and to contribute to modernising surgical mentorship, and quality improvement efforts through augmenting evidence-based training programmes. We have exciting new partnerships to announce in Q1 of 2024 with Proximie Powered Innovation Hubs and Centers of Excellence being announced in key teaching hospitals towards scalable, sustainable and modernised  surgical training models. We are proud to co develop programmes with our local partners and to be guided by our incredible Global Health Steering Committee to ensure we remain dynamically responsive to real-time needs in the communities in which we work.

References:

(1) The Lancet: Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Dr John G Meara, MD et al. April 2015.

(2) The Lancet: Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Dr John G Meara, MD et al. April 2015.

(3) The global health workforce stock and distribution in 2020 and 2030: a threat to equity and ‘universal’ health coverage? Boniol M et. al. BMJ Glob Health. 2022; 7e009316

(4) United Nations. Health – United Nations Sustainable Development [Internet]. [cited 2022 May 31]. Available from: https://www.un.org/sustainabledevelopment/health/

(5) Brighton & Sussex Medical School, Centre for Sustainable Healthcare, and UK Health Alliance on Climate Change (2023). Green surgery: Reducing the environmental impact of surgical care.  London: UKHACC. https://ukhealthalliance.org/sustainable-healthcare/green-surgery-report/