The COVID-19 pandemic has swept across the globe at an unprecedented pace. The first COVID-19 case arrived in Sub-Saharan Africa (SSA) on February 28, 2020, and there are over 600 000 cases spread across the continent [1]. The World Health Organisation has predicted up to a quarter of a billion infections on the continent [2]. In preparation, SSA countries have sharply down-scaled non-COVID-19 health services, including emergency and essential surgical health care (EESC). However, surgical conditions contribute up to a third of the global burden of disease [3]. Surgical health care services are therefore essential to address common conditions that affect mothers, children and adults throughout their lifespan; yet most people in the world (an estimated 5 billion) cannot access such essential care. Scaling down EESC in SSA is likely to have significant and enduring health consequences for the region. Surgery is a vital component of health care services needed to achieve the health priorities in SSA. Several of these priorities are articulated in the Sustainable Development Goals (SDGs) and regional intergovernmental entities [4], and include maternal and child health, injuries and non-communicable diseases. With recent estimates suggesting that postoperative deaths are the third-highest cause of death, globally [5], quality is a significant consideration [6], in addition to expanding access in SSA. However, women are 50 times more likely to die from caesarean sections in SSA compared to their counterparts in high-income countries [7]. Expanding access, in addition to improving the quality of surgical care is, therefore, a requisite for SSA nations to attain health targets in maternal and child health, cancer, injuries and universal health coverage. Before COVID-19, SSA nations were amongst the countries with the most limited access to surgical health care globally [3]; with hindsight, the current pandemic could very well be the “straw that broke the camel's back”, requiring a much harder restart, more significant investment, time and commitment. Safe, timely, and affordable surgical health care is considered a core element of health service delivery, with significant benefits for broader economic growth and sustainable development in SSA [8]. In this paper, we discuss how health system changes due to COVID-19, in particular the preparedness response, are increasing the barriers to EESC in SSA.
