title: Surgical care in low and middle-income countries: burden and barriers.
abstract: Surgically correctable pathology accounts for a sizeable proportion of the overall global burden of disease. Over the last decade the role of surgery in the public health agenda has increased in prominence and attempts to quantify surgical capacity suggest that it is a significant public health issue, with a great disparity between high-income, and low- and middle-income countries (LMICs). Although barriers such as accessibility, availability, affordability and acceptability of surgical care hinder improvements in LMICs, evidence suggests that interventions to improve surgical care in these settings can be cost-effective. Currently, efforts to improve surgical care are mainly coordinated by academia and intuitions with strong surgical and global health interests. However, with the involvement of various international organisations, policy makers, healthcare managers and other stakeholders, a collaborative approach can be achieved in order to accelerate progress towards improved and sustainable surgical care. In this article, we discuss the current burden of global surgical disease and explore some of the barriers that may be encountered in improving surgical capacity in LMICs. We go on to consider the role that international organisations can have in improving surgical care globally. We conclude by discussing surgery as a global health priority and possible solutions to improving surgical care globally.
authors.affiliation: Imperial College London, Exhibition Road, London, SW7 2AZ, England, UK. Electronic address: rele.ologunde09@imperial.ac.uk.
authors.forename: Rele
authors.initials: R
authors.lastname: Ologunde
authors.affiliation: Green Templeton College, Oxford University, Oxford, OX2 6HG, England, UK. Electronic address: mahiben.maruthappu@gtc.ox.ac.uk.
authors.forename: Mahiben
authors.initials: M
authors.lastname: Maruthappu
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Building 149, 13th Street, Navy Yard, Boston, MA 02129, USA. Electronic address: kumaran.shanmugarajah@tbrc.mgh.harvard.edu.
authors.forename: Kumaran
authors.initials: K
authors.lastname: Shanmugarajah
authors.affiliation: Imperial College London, Exhibition Road, London, SW7 2AZ, England, UK. Electronic address: j.shalhoub@imperial.ac.uk.
authors.forename: Joseph
authors.initials: J
authors.lastname: Shalhoub
mesh_terms: D017281:Cost of Illness; D003906:Developing Countries; D006268:Health Facilities / Q000600:supply & distribution; D006292:Health Priorities; D006801:Humans; D007373:Interinstitutional Relations; D007391:International Cooperation; D010349:Patient Compliance; D011634:Public Health; D058996:Quality Improvement; D013514:Surgical Procedures, Operative / Q000592:standards*
keywords: Barriers; Burden; Global surgery