Children's Surgery: The Missing Link in the Global Child Survival Agenda.

Abstract

Global child health is at an inflection point. Under-five mortality has fallen substantially over recent decades, yet progress is slowing and preventable deaths and disability remain concentrated in low- and middle-income countries. As mortality from vaccine-preventable diseases and other infections declines, birth defects and other surgically treatable conditions account for an increasing share of the residual burden. For many children, access to timely, safe and affordable surgical, anesthesia and perioperative care is the difference between survival, disability and death. Yet these services remain insufficiently embedded in child health policy, service delivery and universal health coverage. Children's surgery should therefore be understood not as a peripheral specialty, but as an essential component of integrated services to improve child health outcomes. Congenital anomalies make this case clear. Outcomes for surgically treatable conditions differ starkly by setting, reflecting inequities in early recognition, safe referral, anesthesia, operative and postoperative care, infection prevention, and follow-up. The same services are also required for injuries, burns, surgical infections, complications of sickle cell disease and acute abdominal emergencies. Strengthening them would extend well beyond specialist surgery; it would build the capacity of health systems to respond to some of the most time-sensitive and disabling conditions affecting children. Recent World Health Assembly resolutions on operative care, universal health coverage and newborn screening provide a clear mandate for action. The next phase of the global child survival agenda must recognize children's surgical care as an essential service to be planned, adequately financed and routinely monitored. Integrating surgical, anesthesia, perioperative and rehabilitation care into child health programmes is critical to avert preventable deaths, reduce lifelong disability, protect families from catastrophic costs and ensure that children everywhere have the opportunity not only to survive but also to thrive.