The Continental Surgical Referral Network
Background
African states and households spend substantially on sending patients abroad for complex surgery, and surgical care is a leading driver of catastrophic and impoverishing health expenditure. The 1999 SADC Protocol on Health established a mechanism for the referral of patients for tertiary care, and South Africa subsequently signed agreements covering patient mobility with eleven countries in Southern and Eastern Africa. An analysis of those agreements found them to be high-level instruments containing considerable content on health diplomacy but little on health governance, management and delivery and specifically on surgical care. PASHeF as a Member State-owned intergovernmental platform is ideally situated to establish inter-member state referral system for surgical care management that will eventually reduce cost incurred by cases leaving the continent.
Objective
To establish the evidence base and the standards required for formalised intra-African referral for complex surgery, so that patients and the expenditure that follows them are retained on the continent.
Approach
and launch
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The outflow study: PASHeF Research subcommittee will use member states with an overseas treatment board or fund to publish a single figure that summarizes what African states and households spend sending surgical patients outside the continent.
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Standard and legal review: A designation standard for receiving centres, developed through the same consensus procedure as the indicators package, plus a review of what existing regional instruments already provide.
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Establishing the one corridor: A single clinical domain between two willing ministries, anchored in a Regional Economic Community, with prepayment or per case.
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Continental instrument: After testing a corridor that may demonstrably work, a framework will be tabled to member states based on country capacity and regional hubs.
MONITORING AND EVALUATION FRAMEWORK
Inputs
Data analyst for four months, Under the Research Subcommittee | Overseas treatment board records from member upto 10 states. | A Regional Economic Community as institutional anchor.
Outputs
Published continental outflow figure | Designation standard for receiving centres | legal gap analysis of existing instruments
Outcomes
One working corridor with prepaid per-case referral by 2029 | Every referral carrying a training obligation for the sending country.
Impact
A measurable share of outbound surgical referral and its associated expenditure, retained within Africa.