title: Providing more than health care: the dynamics of humanitarian surgery efforts on the local microeconomy.
abstract: Humanitarian cleft surgery has long been provided by teams from resource-rich countries traveling for short-term missions to resource-poor countries. After identifying an area of durable unmet need through surgical missions, Operation Smile constructed a permanent center for cleft care in Northeast India. The Operation Smile Guwahati Comprehensive Cleft Care Center (GCCCC) uses a high-volume subspecialized institution to provide safe, quality, comprehensive, and cost-effective cleft care to a highly vulnerable patient population in Assam, India. The purpose of this study was to profile the expenses of several cleft missions carried out in Assam and to compare these to the expenditures of the permanent comprehensive cleft care center. We reviewed financial data from 4 Operation Smile missions in Assam between December 2009 and February 2011 and from the GCCCC for the 2012-2013 fiscal year. Expenses from the 2 models were categorized and compared. In the studied period, 33% of the mission expenses were spent locally compared to 94% of those of the center. The largest expenses in the mission model were air travel (48.8%) and hotel expenses (21.6%) for the team, whereas salaries (46.3%) and infrastructure costs (19.8%) made up the largest fractions of expenses in the center model. The evolution from mission-based care to a specialty hospital model in Guwahati incorporated a transition from vertical inputs to investments in infrastructure and human capital to create a sustainable local care delivery system.
authors.affiliation: From the *Program in Global Surgery and Social Change, and †Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; ‡University of Nebraska College of Medicine, Omaha, Nebraska; §Department of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, Massachusetts; ∥Operation Smile, Virginia Beach, Virginia; ¶Center for Surgery and Public Health, and #Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Nagengast
authors.forename: E J
authors.initials: EJ
authors.lastname: Caterson
authors.forename: William P
authors.initials: WP
authors.lastname: Magee
authors.forename: Kristin
authors.initials: K
authors.lastname: Hatcher
authors.forename: Margarita S
authors.initials: MS
authors.lastname: Ramos
authors.forename: Alex
authors.initials: A
authors.lastname: Campbell
mesh_terms: D000533:Altruism; D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000601:surgery*; D003191:Comprehensive Health Care / Q000191:economics*; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D004517:Education, Professional / Q000191:economics; D004864:Equipment and Supplies / Q000191:economics; D004865:Equipment and Supplies, Hospital / Q000191:economics; D005102:Health Expenditures; D006739:Hospital Administration / Q000191:economics; D006782:Hospitals, Special / Q000191:economics* / Q000458:organization & administration; D006801:Humans; D007194:India; D007449:Investments; D008493:Medical Missions / Q000191:economics*; D012456:Salaries and Fringe Benefits; D014186:Transportation / Q000191:economics; D014195:Travel / Q000191:economics; D035862:Vulnerable Populations