Feb 4, 2013 KV Kiva HQ
By Emily Wakefield
How can we make surgery affordable in developing markets?
Minor or routine surgery is a regularly available health option for many of us. But for the 1.3 billion people living on less that US$1.25 per day, there is no such thing as disposable income. For them and millions more, surgery of any magnitude is a luxury.  

According to the World Health Organization:

In Uganda, there are less than 100 practicing surgeons serving a population of about 24 million -- that’s 1 surgeon for every 30,000 patients.

In Gambia and Malawi, there are no qualified anesthesiologists. This means that, when necessary, they have to “import” specialists to perform surgeries -- making the costs even more exorbitant.

Worldwide, an estimated 500,000 women die annually from pregnancy-related complications that require surgical intervention.

There’s an incorrect assumption that advanced surgeries are too sophisticated for doctors in the developing world. This means that even if surgery was an affordable option, there wouldn’t be anyone to perform many procedures. In many cases, there are no literally alternatives for millions of people affected by congenital conditions, infections, accidents and burns.

One serious health concern in developing countries is the result of muscle, bone, or joint infection. These infections are easily treated by draining the wounds as long as there is access to safe anesthesia, but when left untreated, can result in permanent disability or even death.

Another common condition that is especially prevalent is cleft lip and cleft palate. Every year, many children are born with gaps in their lips or roofs of their mouths, making it difficult to speak or eat. While both are easy to treat early in life through simple surgery, those who go without are often stigmatized, and even prevented from attending school or getting a job.

Like cleft palate, club foot is a congentital condition easily and effectively fixed by a casting treatment in the first weeks of a baby’s life. When left untreated, it can result in the difficulty or inability to walk, infections, and chronic pain. In the developing world, an estimated 80,00 babies are born every year with club foot, and the vast majority are poorly treated or not treated at all.

Kiva is working on financing solutions for health care and surgeries. Already, we’ve introduced a “Health” sector on the Lend page for loans to help borrowers buy medicine and other supplies to get them back on their feet. But we’d like to go further to make quality care affordable.

In the meantime, we’re thrilled to see other organizations emerging to tackle this problem. Most recently, Watsi -- a nonprofit organization that connects donors with patients throughout the world who can’t afford basic, but high-impact procedures -- became the first nonprofit to be selected by Y Combinator. Watsi’s structure is somewhat similar to Kiva, with users browsing profiles of patients and funding their treatments -- only what they give are donations, not loans.

For example, Channa is a 9 year-old from Cambodia who needed just $350 to fix congenital cataracts that limited his sight to half meter in front of him. With this relatively small amount of money, doctors will be able to completely restore his vision.

While there’s still considerable progress to be made, we believe that microfinance can make a huge difference in many parts of people’s lives. While Kiva plans to provide loans for health care, we believe that as economic opportunity expands, incomes will rise, more people will get the education they deserve, and basic health care and surgeries will become much more accessible.

Have questions about Kiva? Send them our way at blog@kiva.org.

Images courtesy of Barrick Beyond Borders and Watsi.


Wouldn't it also be great if they were able to train medical specialists in those countries so they didn't need outside help all the time. Funding a medical school would be a great idea.

Thanks for the Kiva love, guys! All of us at Watsi are honored to be featured on the Kiva blog :)

Hope you'll keep us updated on how things continue along Grace :)

Thank you for addressing the pressing need for surgical care in the developing world, an issue I care deeply about. While I agree that surgical care providers are greatly lacking in countries like Malawi, your focus on the lack of anesthesiologists implies that there is no anesthesia care currently being delivered in the country. This assertion does a disservice to the many nurse anesthetists who are working to provide excellent anesthesia care in Malawi, and in fact, most of the developing world. I worked in a public hospital in Malawi from 2011-2012 assisting in the treatment of surgical diseases. Our surgical team contained two fully-trained Malawian anesthetists, and four other fully-trained anesthetists were also working in the hospital. Although none of them were anesthesiologists, having not completed an accredited residency program, they were trained as nurses and received further anesthesia training to become nurse anesthetists. They were incredibly skilled and competent providers, and have counterparts working across the country. Although there is definitely a shortage of trained anesthesia specialists in the country (along with a shortage of many other medical professionals), training programs do exist in Malawi to prepare skilled nurse anesthetists, who go on to provide low-cost, high-level care services. There is no anesthesiology residency program - Malawians would have to leave the country for training, and might be offered higher pay outside and never return. What is needed in Malawi is not anesthesiologists necessarily, but a cadre of well-trained anesthesia providers, and that includes nurse anesthetists. High-cost specialists are indeed “imported” to Malawi, but often to supplement the existing nurse anesthetists and clinical officers who are providing much life-saving surgery.

Go Watsi!

Thanks for the article in which you addressed the issue of need for surgical care in the developing world. Really presence of specialists is needed but i want to disagree on the issue of importing specialists to perform surgery. I am one of the trained Anesthetic Clinical Officers ,who provide anesthesia care in Malawi. We are doing both minor as well as major surgeries ;with good outcome of course.We also have HDU &ICU s across the country managed by Anaesthetic Clinical Officers and Nurse anesthetist ----Yohann

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A native of southern California, Emily is a recent graduate from Santa Clara University where she studied Economics and Spanish Studies. The highlight of her college experience was the semester she spent abroad in Granada, Spain. She knew she wanted to pursue a career in economic development after reading Half the Sky. Emily will be joining the Marketing and Communications team as a Blog and Social Media Intern and is especially excited to find new and creative ways to spread Kiva’s work to more people. In her spare time, she enjoys reading, listening to country music, and re-watching Friends episodes for the millionth time. 

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