Access to EESC is a crucial component of universal health coverage (UHC). A recent modelling study concluded that 866 449 procedures in SSA would be cancelled or postponed during the peak 12 weeks of disruption due to COVID-19, including 737 967 benign, 82 037 cancer and 46 445 obstetric operations [9]. Heightened barriers will result in an increase in avoidable morbidity and mortality due to common EESC, including traumatic injuries, burns, advanced cancer, lower limb ischemia from poorly managed diabetes, and other consequences of untreated conditions in subsequent months.

The barriers to access EESC can be understood through the Three Delays Framework, which classifies barriers into seeking, reaching, and receiving care (Figure 1)[3]. The fear of contracting COVID-19 from a health facility and the lack of public awareness of available non-COVID-19 health services during lockdown could prevent persons from seeking surgical health care. Many have lost formal and informal employment, and those with surgical health conditions may not have the financial resources to seek or receive care [10]. There are increased barriers to reaching surgical health care due to a lack of public transport services during lockdown periods. Patients depend on public transport to travel to hospitals since pre-hospital emergency medical services, including the availability of ambulances, are severely limited in SSA [11]. Barriers to receiving surgical health care (for instance, life-saving caesarian sections or cancer resections, limb-salvaging management of fractures, or neonates born with congenital anomalies) have increased due to health system changes in service delivery and the allocation of resources. To reduce hospital admissions, facilities have cancelled both outpatient consultations and elective operations. Operating theatres and inpatients wards–indispensable resources of the surgical ecosystem–have proven to be indispensable assets for COVID-19 management, and have been consequently, repurposed [12].