title: A framework for the monitoring and evaluation of international surgical initiatives in low- and middle-income countries.
abstract: BACKGROUND
  An estimated two billion people worldwide lack adequate access to surgical care. To address this humanitarian emergency, an increasing number of international surgical partnerships are emerging between developed and low- and middle-income countries (LMICs). At present, there are no clear indicators that may be used to assess the effectiveness of such initiatives.
  
  
  METHODS
  We conducted an international qualitative study of 31 surgeons from developed and LMICs involved in international partnerships across a variety of subspecialties. Thematic analysis and grounded theory were applied in order to develop a practical framework that may be applied to monitor and evaluate global surgical initiatives.
  
  
  RESULTS
  Several themes emerged from the study: (i) there is a large unmet need to establish and maintain prospective databases in LMICs to inform the monitoring and evaluation of international surgical partnerships; (ii) assessment of initiatives must occur longitudinally over the span of several years; (ii) the domains of assessment are contextual and encompass cultural, institutional and regional factors; and (iv) evaluation strategies should explore broader impact within the community and country. Based on thematic analysis within the domains of inputs, outputs and outcomes, a framework for the monitoring and evaluation of international surgical initiatives, the Framework for the Assessment of InteRNational Surgical Success (FAIRNeSS) is proposed.
  
  
  CONCLUSIONS
  In response to the increasing number of surgical partnerships between developed and LMICs, we propose a framework to monitor and evaluate international surgical initiatives.
authors.affiliation: Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada.
authors.forename: George M
authors.initials: GM
authors.lastname: Ibrahim
authors.affiliation: Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada.
authors.forename: David W
authors.initials: DW
authors.lastname: Cadotte
authors.affiliation: Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Bernstein
mesh_terms: D003906:Developing Countries; D014943:Global Health; D006268:Health Facilities; D006801:Humans; D011203:Poverty; D015397:Program Evaluation
references.citation: Ann Surg. 2015 Apr;261(4):807-11
references.pmid: 24915782
references.citation: Lancet. 2014 Jan 4;383(9911):12-13
references.pmid: 24332309
references.citation: Br J Neurosurg. 2012 Jun;26(3):326-30
references.pmid: 22122712
references.citation: World J Surg. 2006 Apr;30(4):505-11
references.pmid: 16528459
references.citation: PLoS Med. 2008 Aug 26;5(8):e182
references.pmid: 18752346
references.citation: World Neurosurg. 2013 Dec;80(6):e171-4
references.pmid: 23871816
references.citation: Arch Surg. 2010 Feb;145(2):154-9
references.pmid: 20157083
references.citation: J Craniofac Surg. 2015 Jun;26(4):1121-5
references.pmid: 26080139
references.citation: World Neurosurg. 2014 Nov;82(5):560-6
references.pmid: 24836580
references.citation: World Neurosurg. 2010 Apr;73(4):259-60
references.pmid: 20849773
references.citation: Lancet. 2012 Sep 22;380(9847):1082-7
references.pmid: 22898076
references.citation: World Neurosurg. 2010 Apr;73(4):270-5
references.pmid: 20849776
references.citation: World J Surg. 2011 Jun;35(6):1175-82
references.pmid: 21487850
references.citation: World J Surg. 2008 Apr;32(4):533-6
references.pmid: 18311574
references.citation: Can J Surg. 2004 Jun;47(3):170-2
references.pmid: 15264377
references.citation: World Neurosurg. 2013 Dec;80(6):751-8
references.pmid: 23474185
references.citation: Lancet. 2010 Sep 25;376(9746):1055-61
references.pmid: 20598365