Barriers and enablers to country adoption of National Surgical, Obstetric, and Anesthesia Plans

Abstract

This paper examines the adoption and diffusion of National Surgical Obstetric and Anaesthesia Plans (NSOAPs), a policy instrument, to improve surgical healthcare services in low- and middle-income countries (LMICs). It draws on recent trends in health system reform and empiricism to understand NSOAP effectiveness for large-scale improvement in surgical system objectives (surgical outcomes, patient satisfaction and financial risk protection). While the study reveals that NSOAP adoption has occurred in several countries, its translation into effective, responsive and equitable coverage of surgical healthcare services (diffusion) with enduring impact has yet to occur on a large-scale. NSOAP adoption and diffusion has been constrained by two principal considerations: (I) suboptimal funding allocation to develop NSOAPs and implement within a health system context; (II) inadequate translation of the NSOAP into implementable activities that lead to improved health system performance. We argue that a systems perspective-dynamically optimizing the NSOAP in relation to specific health system, adoption system, and contextual factors-may enhance the scale-up of NSOAPs and lead to sustainably funded programs that enhance the effectiveness, efficiency, responsiveness and equity of surgical healthcare service over the long-term. We explore three specific areas-technology, financing, governance-which could be harnessed to enhance the adoption and diffusion of NSOAPs.