title: Financial contribution to global surgery: an analysis of 160 international charitable organisations.
abstract: BACKGROUND
  The non-profit and volunteer sector provides substantial contributions to global health. Within the field of surgery, this sector has made notable service contributions in low-income and middle-income countries (LMICs) where access to surgical care is poor. Little is known about financing and funding flows to surgical care in LMICs from both domestic and international sources. Because an estimated 55% of surgical care delivered in LMICs is via charitable organisations, understanding the financial contributions of this sector could provide valuable insight into estimating funding flows and understanding financing priorities in global surgery.
  
  
  METHODS
  Between June, and September, 2014, we searched public online databases of registered charitable organisations in five high-income nations (the USA, the UK, Canada, Australia, and New Zealand) to identify organisations committed exclusively to surgical needs. Based on availability, the most current 5 years (2007-13) of financial data per organisation were collected. For each charitable organisation, we identified the type of surgical services provided. We examined revenues and expenditures for each organisation.
  
  
  RESULTS
  160 organisations representing 15 different surgical specialties were included in the analysis. Total aggregated revenue over the years 2008-2013 was US$3·3 billion. Total aggregated expenses for all 160 organisations amounted to US$3·0 billion. 28 ophthalmology organisations accounted for 45% of revenue and 49% of expenses. 15 cleft lip and palate organisations totalled 26% of both revenue and expenses. 19 organisations providing a mix of diverse surgical specialty services amounted to 14% of revenue and 16% of expenses. The remaining 15% of funds represented 12 specialties and 98 organisations. The US accounted for 77·7% of revenue and 80·8% of expenses. The UK accounted for 11·0% of revenue and 11·91% of expenses. Canada accounted for 1·85% of revenue and 2·01% of expenses. Australia and New Zealand accounted for 4·94% of revenue and 5·29% of expenses.
  
  
  CONCLUSIONS
  Charitable organisations addressing surgical conditions primarily focus on elective surgical care and cover a broad range of subspecialties. The largest funding flows from charitable organisations are directed at ophthalmology, followed by cleft lip and palate surgery. However, there is a clear need for improved, transparent tracking of funds to global surgery via charitable organisations.
  
  
  BACKGROUND
  None.
authors: Department of Surgery, Montefiore Medical Center, Bronx, NY, USA; UNC Project Malawi, Lilongwe, Malawi; Center for Surgery and Public Health, Boston, MA, USA. Electronic address: lily.gutnik@mail.harvard.edu.
authors: Lily A
authors: LA
authors: Gutnik
authors: Evidence to Policy Initiative, Global Health Group, University of California San Francisco, San Francisco, CA, USA.
authors: Gavin
authors: G
authors: Yamey
authors: King's Centre for Global Health, King's Health Partners and King's College London, London, UK.
authors: Anna J
authors: AJ
authors: Dare
authors: Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
authors: Margarita S
authors: MS
authors: Ramos
authors: Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA; Center for Surgery and Public Health, Boston, MA, USA.
authors: Robert
authors: R
authors: Riviello
authors: Harvard Medical School, Boston, MA, USA; Boston Children's Hospital, Boston, MA, USA.
authors: John G
authors: JG
authors: Meara
authors: Harvard University Interfaculty Initiative in Health Policy, Cambridge, MA, USA; Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA; Program in Global Surgery and Social Change, Children's Hospital Boston, Boston, MA, USA.
authors: Mark G
authors: MG
authors: Shrime