Intended for healthcare professionals

Analysis Health in South Asia

Unmet need for surgery in South Asia

BMJ 2017; 357 doi: (Published 11 April 2017) Cite this as: BMJ 2017;357:j1423
  1. Sanjay Nagral, senior consultant1,
  2. Maharra Hussain, specialist general surgeon2,
  3. Sarder A Nayeem, chief laparoscopic surgeon3,
  4. Ranjan Dias, senior lecturer in paediatric surgery4,
  5. S Ather Enam, professor of neurosurgery5,
  6. Samiran Nundy, senior consultant6
  1. 1Department of Surgical Gastroenterology, Jaslok Hospital and Research Centre, Mumbai, India
  2. 2Department of Surgery, Mediclinic Welcare Hospital, Dubai, United Arab Emirates
  3. 3Japan Bangladesh Friendship Hospital (JBFH), Dhaka, Bangladesh
  4. 4University of Colombo, Lady Ridgeway Hospital for Children, Colombo, Sri Lanka
  5. 5Department of Surgery, The Aga Khan University, Karachi, Pakistan
  6. 6Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
  1. Correspondence to: S Nagral sanjaynagral{at}

Despite increased specialisation and technology, surgical care in the world’s most populous region is inequitable and remains inaccessible to most people, say Sanjay Nagral and colleagues

Surgical disorders are a substantial burden. Surgery is a cost effective method to return sick and injured people to health and work.1 The Lancet Commission on Global Surgery reports that nearly a third of the global burden of disease can be attributed to surgically treatable conditions.2 South Asia has the highest unmet surgical need in the world,2 and surgical care is out of reach for most people. This is because of the political economy of the region, which has produced an underfunded and inefficient public sector and a dominant private sector.3 Reforming surgical care is therefore a priority for the region.

In this article, we review the rapidly changing situation of surgical care in South Asia. Although recent high quality regional data on the surgical infrastructure, workforce, and outcomes are lacking, there are several cultural, financial and structural barriers that prevent access to surgery.4 We propose a course of action for the surgical community and governments of the region to improve the accessibility, equity, and quality of surgical care in South Asia.

Epidemiology of surgical disease

Surgical disease in South Asia is characterised by late presentation and coexisting malnutrition.5 Patients with cancer tend to present at a much later stage of the disease than in the developed world.6 The region also has a large burden of infectious diseases such as amoebic liver abscess, worm infestation, filariasis, and leprosy, many of which need surgery. Furthermore, non-communicable diseases and rapid urbanisation have increased the burden on surgical services. In the past few decades, there has been a rise in non-communicable diseases such as diabetes, hypertension, and ischaemic heart disease. These may require surgery, …

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