title: Surgical Care and Health Systems.
abstract: BACKGROUND
  While surgical care impacts a wide variety of diseases and conditions with non-operative and operative services, both preventive and curative, there has been little discussion concerning how surgery might be integrated within the health system of a low and middle-income country (LMIC), nor how strengthening surgical services may improve health systems and population health.
  
  
  METHODS
  We reviewed reports from several meetings of the working group on health systems strengthening of the Global Initiative for Emergency and Essential Surgical Care, and also performed a review of the literature including the search terms "surgery," "health system," "developing country," "health systems strengthening," "health information system," "financing," "governance," and "integration."
  
  
  RESULTS
  The literature search revealed no reports which focused on the integration of surgical services within a health system or as a component of health system strengthening. A conceptual model of how surgical care might be integrated within a health system is proposed, based on the discussions of our working group, combined with sources from the medical literature, and utilizing the World Health Organization's conceptual model of a health system.
  
  
  CONCLUSIONS
  Strengthening the delivery of surgical services in LMICs will require inputs at multiple levels within a health system, and this effort will require the coalescence of committed individuals and organizations, supported by civil society.
authors.affiliation: Division of Orthopaedic Surgery, Childrens Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, USA, spiegeld@email.chop.edu.
authors.forename: David A
authors.initials: DA
authors.lastname: Spiegel
authors.forename: Mohit
authors.initials: M
authors.lastname: Misra
authors.forename: Peter
authors.initials: P
authors.lastname: Bendix
authors.forename: Lars
authors.initials: L
authors.lastname: Hagander
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Bickler
authors.forename: C Omar
authors.initials: CO
authors.lastname: Saleh
authors.forename: Martin
authors.initials: M
authors.lastname: Ekeke-Monono
authors.forename: Dinah
authors.initials: D
authors.lastname: Baah-Odoom
authors.forename: Amber
authors.initials: A
authors.lastname: Caldwell
authors.forename: Beryl
authors.initials: B
authors.lastname: Irons
authors.forename: Sheik
authors.initials: S
authors.lastname: Amir
authors.forename: Robert
authors.initials: R
authors.lastname: Taylor
authors.forename: Maya
authors.initials: M
authors.lastname: Layne
authors.forename: Helena
authors.initials: H
authors.lastname: Hailu
authors.forename: Syed Mohammad
authors.initials: SM
authors.lastname: Awais
authors.forename: Raymond R
authors.initials: RR
authors.lastname: Price
authors.forename: Sarah
authors.initials: S
authors.lastname: Crockett
authors.forename: Monir
authors.initials: M
authors.lastname: Islam
mesh_terms: D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000458:organization & administration*; D003906:Developing Countries; D013502:General Surgery / Q000191:economics / Q000458:organization & administration*; D063005:Health Information Systems; D006801:Humans; D017146:Models, Organizational