title: Value innovation: an important aspect of global surgical care.
abstract: BACKGROUND
  Limited resources in low- and middle-income countries (LMICs) drive tremendous innovation in medicine, as well as in other fields. It is not often recognized that several important surgical tools and methods, widely used in high-income countries, have their origins in LMICs. Surgical care around the world stands much to gain from these innovations. In this paper, we provide a short review of some of these successful innovations and their origins that have had an important impact in healthcare delivery worldwide.
  
  
  METHODS
  Examples of LMIC innovations that have been adapted in high-income countries include the Bogotá bag for temporary abdominal wound closure, the orthopaedic external fixator for complex fractures, a hydrocephalus fluid valve for normal pressure hydrocephalus, and intra-ocular lens and manual small incision cataract surgery. LMIC innovations that have had tremendous potential global impact include mosquito net mesh for inguinal hernia repair, and a flutter valve for intercostal drainage of pneumothorax.
  
  
  CONCLUSIONS
  Surgical innovations from LMICs have been shown to have comparable outcomes at a fraction of the cost of tools used in high-income countries. These innovations have the potential to revolutionize global surgical care. Advocates should actively seek out these innovations, campaign for the financial gains from these innovations to benefit their originators and their countries, and find ways to develop and distribute them locally as well as globally.
authors.affiliation: International Collaboration for Essential Surgery (ICES), London, UK. mikeytha@gmail.com.
authors.forename: Michael
authors.initials: M
authors.lastname: Cotton
authors.forename: Jaymie Ang
authors.initials: JA
authors.lastname: Henry
authors.forename: Lauren
authors.initials: L
authors.lastname: Hasek
mesh_terms: D003906:Developing Countries; D004059:Diffusion of Innovation; D013502:General Surgery / Q000191:economics* / Q000458:organization & administration*; D014943:Global Health; D006801:Humans