Barriers to National Surgical Healthcare Policy Development & Implementation in the Southern African Development Community

Background Despite high-level commitment from governments, national surgical healthcare policy development has been slower than expected across the Southern African Development Community (SADC). This regional survey study aims to identify perceived barriers to policy formulation and, where applicable, implementation. Methods A combination of convenience, purposive and snowball sampling techniques were used to distribute an electronic survey to SADC surgical care stakeholders. Adaptive questioning was utilised to evaluate perceived potential barriers by each respondent, including government support for national surgical policy, the existence of a taskforce, resourcing for policy development, and specific challenges mapped to domains of the National Surgical, Obstetric and Anaesthesia Plan (NSOAP) Manual. Results Of 182 participants that consented to participation, 60% (n=109) responded in full and 22% (n=40) logged a partial response that was included in the analysis. 14/16 SADC countries were represented. 60% of respondents identified as healthcare professionals, 23% were academics and 24% represented government; there was poor representation from NGOs, civil society and potential donors. Twenty-seven percent (n=32) of respondents indicated that their country’s government supports and is driving the NSOAP development process. Financing (n=41, 82%) and stakeholder engagement (n=40, 80%) were the domains most commonly cited as barriers to developing a national surgical health plan. Respondents from three countries that had published NSOAPs cited inadequate integration into existing health plans and insufficient funding as common barriers to implementation. Conclusions There is a generalised perception of limited political conviction to drive national surgical improvement across the region, as well as funding and stakeholder engagement being significant barriers. For safe, timely, and affordable surgical care to become a reality, SADC governments need to exhibit strong leadership and engage potential funders (national treasury, intergovernmental and non-governmental organisations, philanthropies, private industry) early, to envision a sustainable financing model for surgical healthcare.