Advancing Global Surgery and Universal Health Coverage in Africa: A Multi-Stakeholder Imperative

Abstract

Surgical disease contributes substantially to Africa’s overall health burden, with an estimated 1.16 million deaths annually attributable to conditions that are preventable or treatable through timely surgical intervention. Despite growing global momentum toward universal health coverage (UHC), surgical and anaesthesia care remain systematically under-prioritised in national health policies, financing mechanisms, and service delivery models across much of the continent. This article examines the imperative for a coordinated, multi-stakeholder approach—encompassing governments, clinicians, academia, industry, and civil society—to advance equitable, accessible, and cost-effective surgical care in Africa. Drawing on Afrimed’s experience as a medical innovation company and cross-referencing selected African case studies, the article demonstrates how local research, innovation, and manufacturing can complement policy reforms and health system strengthening efforts to accelerate progress in global surgery.

Introduction

The modern global surgery movement, catalysed by the Lancet Commission on Global Surgery in 2015, articulated a compelling vision: that safe, timely, and affordable surgical and anaesthesia care should be universally accessible. The Commission reframed surgery not as a specialised or optional service, but as a core pillar of public health, economic development, and human capital formation. For Africa, where an estimated nine out of ten people lack access to essential surgical services, this challenge is particularly acute.

Surgical care underpins the management of a wide spectrum of conditions—from emergency trauma and obstetric complications to non-communicable diseases (NCDs) such as cancer, cardiovascular disease, and congenital anomalies. As demographic transitions, urbanisation, and epidemiological shifts accelerate across Africa, demand for surgical services is expected to rise sharply. Yet health systems remain ill-equipped to meet this demand, constrained by workforce shortages, infrastructure gaps, supply chain inefficiencies, and limited financing.

Afrimed, through convenings such as its afriTALK™ Panel on Multi-Stakeholder Approaches to Global Surgery (2023), positions itself at the intersection of innovation, industry, and advocacy. This article situates Afrimed’s perspective within the broader academic discourse on UHC and global surgery, arguing that surgical equity must be deliberately embedded within Africa’s health systems agenda rather than treated as a peripheral concern.

The Burden of Surgical Disease in Africa

The mismatch between surgical need and surgical provision in Africa remains stark and persistent. Sub-Saharan Africa bears approximately 25% of the global disease burden, yet is served by only about 3% of the global health workforce. Surgical volumes across the region remain well below the Lancet Commission’s benchmark of 5,000 procedures per 100,000 population per year, reflecting both limited capacity and constrained access.

Delays in accessing surgical care—often due to geographic distance, cost barriers, referral inefficiencies, or shortages of skilled personnel—contribute directly to avoidable mortality and disability. Trauma from road traffic injuries, obstructed labor, acute abdominal emergencies, and treatable congenital conditions continue to claim lives that could be saved through timely intervention.

Beyond the human toll, the economic consequences of inadequate surgical care are profound. It is estimated that low- and middle-income countries could face cumulative GDP losses of up to USD 12.3 trillion by 2030 if surgical systems are not adequately scaled. These losses stem from premature mortality, long-term disability, reduced workforce participation, and catastrophic health expenditures that push households into poverty. In this context, investment in surgical care should be understood not only as a health priority, but as a macroeconomic and development imperative.

Multi-Stakeholder Approaches to Surgical Equity

Addressing Africa’s surgical gap requires coordinated action across multiple sectors, each contributing distinct but interdependent capabilities.

Governments and Policymakers

National governments play a central role in setting priorities, mobilising resources, and integrating surgical care into broader health system reforms. The development of National Surgical, Obstetric and Anaesthesia Plans (NSOAPs) in countries such as Zambia, Tanzania, and Ethiopia illustrates how surgical care can be institutionalised within national health strategies. NSOAPs provide a structured framework for workforce development, infrastructure investment, service delivery, information systems, and governance.

However, policy articulation alone is insufficient. Effective implementation requires sustainable financing, regulatory alignment, and explicit integration with UHC benefit packages. Without these elements, surgical plans risk remaining aspirational documents rather than operational tools for change.

Clinicians and Academia

Clinicians and academic institutions are central to building and sustaining surgical capacity. Training, mentorship, and continuous professional development are essential to address workforce shortages and skills gaps. Regional initiatives such as the College of Surgeons of East, Central and Southern Africa (COSECSA) demonstrate the potential of collaborative, context-adapted training models. By expanding accredited training across more than 14 countries, COSECSA has strengthened local capacity while reducing reliance on external training pathways.

Academic institutions also play a critical role in generating locally relevant evidence, informing policy, and evaluating system performance.

Industry and Innovation

The medical technology industry has a growing role to play in advancing surgical equity, particularly through localised innovation and manufacturing. Afrimed’s focus on developing cost-effective surgical technologies—such as the afriseal™ vessel sealing system—reflects a broader shift toward context-appropriate design. Local production can reduce dependency on imports, shorten procurement timelines, lower costs, and improve resilience in supply chains.

Such efforts align with African Union industrialisation and health sovereignty objectives, including the Pharmaceutical Manufacturing Plan for Africa and its medical devices supplement. When coupled with supportive regulatory frameworks, local manufacturing can become a strategic enabler of UHC.

Civil Society and Patients

Civil society organisations and patient advocacy groups provide an essential accountability function within health systems. Initiatives such as Safe Surgery 2020 in Tanzania demonstrate how community engagement, advocacy, and data transparency can catalyse improvements in surgical quality and access. Elevating patient voices ensures that reforms remain grounded in lived experience and responsive to real-world barriers.

Case Studies Across Africa

Africa’s diversity of contexts has produced a range of innovative approaches to surgical system strengthening.

Ethiopia’s NSOAP Implementation: Launched in 2016, Ethiopia’s NSOAP was among the first on the continent. Despite significant resource constraints, it demonstrated how coordinated leadership, clear targets, and monitoring frameworks can drive incremental improvements in infrastructure, workforce distribution, and service delivery.

Rwanda’s Digital Surgery Integration: Rwanda has leveraged digital health tools, including tele-mentoring platforms, to support surgical teams in rural and remote areas. These interventions have contributed to improved surgical decision-making and reductions in maternal and neonatal mortality, illustrating the potential of technology-enabled care models.

South Africa’s Medical Device Manufacturing: South Africa’s emerging medical device manufacturing ecosystem highlights the feasibility of African-led innovation. Companies such as Afrimed demonstrate how locally designed and manufactured devices can address procurement delays, reduce costs, and offer solutions tailored to regional clinical realities.

Sierra Leone’s Post-Ebola Reforms: Following the Ebola outbreak, Sierra Leone integrated surgical system strengthening into broader health system recovery efforts. This experience underscores how crisis response and resilience-building can be leveraged to advance long-term surgical capacity.

The Role of Local Research and Development

African-led research is indispensable for ensuring that surgical policies and technologies are fit for purpose. Studies examining laparoscopic surgery adoption in Ghana or trauma system gaps in Kenya illustrate how locally generated data can inform evidence-based policymaking. Without such data, health systems risk importing models that are misaligned with resource constraints or population needs.

Afrimed’s innovation model aligns with this research imperative by embedding product development and evaluation within Africa’s healthcare landscape. By linking R&D to clinical realities, local innovation can accelerate the translation of evidence into practice.

Recommendations

To advance surgical equity and UHC in Africa, the following actions are recommended:

• Policy Integration: Embed surgical and anesthesia care explicitly within UHC roadmaps and national financing frameworks.

• Capacity Building: Expand regional training consortia, south–south collaborations, and mentorship networks.

• Innovation and Manufacturing: Strengthen Africa’s capacity for medical device R&D and local production to improve affordability and access.

• Patient-Centered Advocacy: Institutionalize civil society participation in surgical planning and evaluation.

• Multi-Sector Partnerships: Foster sustained collaboration among governments, academia, industry, and non-governmental organizations.

Conclusion

Global surgery is not a luxury or a tertiary concern; it is a foundational component of universal health coverage and resilient health systems. For Africa, closing the surgical access gap demands coordinated, multi-stakeholder approaches that integrate policy reform, workforce development, innovation, and local manufacturing. Afrimed’s experience illustrates how African medical innovation companies can serve as catalysts—bridging the divide between technological advancement and systemic health equity. Achieving equitable, accessible, and cost-effective surgical care is not only a health objective, but a socio-economic imperative for the continent.

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