title: Problems and solutions in delivering global surgery in the 21st century.
abstract: BACKGROUND
  Surgery has had low priority in global health planning, so the delivery of surgical care in low- and middle-income countries is often poorly resourced. A recent Lancet Commission on Global Surgery has highlighted the need for change.
  
  
  METHODS
  A consensus view of the problems and solutions was identified by individual surgeons from high-income countries, familiar with surgical care in remote and poorer environments, based on recent publications related to global surgery.
  
  
  RESULTS
  The major issues identified were: the perceived unimportance of surgery, shortage of personnel, lack of appropriate training and failure to establish surgical standards, failure to appreciate local needs and poor coordination of service delivery.
  
  
  CONCLUSIONS
  Surgery deserves a higher priority in global health resource allocation. Lessons learned from participation in humanitarian crises should be considered in surgical developments.
authors.affiliation: Colorectal Department, Royal Devon and Exeter Hospital, Exeter, UK.
authors.forename: F D
authors.initials: FD
authors.lastname: McDermott
authors.affiliation: St Vincent's University Hospital, Dublin, Ireland.
authors.forename: M E
authors.initials: ME
authors.lastname: Kelly
authors.affiliation: Colorectal Department, Royal Devon and Exeter Hospital, Exeter, UK.
authors.forename: A
authors.initials: A
authors.lastname: Warwick
authors.affiliation: Surgical Division, Colchester University Hospital, Colchester, UK.
authors.forename: T
authors.initials: T
authors.lastname: Arulampalam
authors.affiliation: East Midlands Major Trauma Centre, Queen's Medical Centre, Nottingham University Hospital, Nottingham, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Brooks
authors.affiliation: Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway.
authors.forename: T
authors.initials: T
authors.lastname: Gaarder
authors.affiliation: Division of Acute Care Surgery, University of Texas Health Science Center, Houston, Texas, USA.
authors.forename: B A
authors.initials: BA
authors.lastname: Cotton
authors.affiliation: St Vincent's University Hospital, Dublin, Ireland.
authors.forename: D C
authors.initials: DC
authors.lastname: Winter
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration*; D013502:General Surgery / Q000458:organization & administration*; D006301:Health Services Needs and Demand / Q000458:organization & administration*; D006801:Humans; D011634:Public Health