title: Financial contributions to global surgery: an analysis of 160 international charitable organizations.
abstract: BACKGROUND
  The non-profit and volunteer sector has made notable contributions to delivering surgical services in low-and middle-income countries (LMICs). As an estimated 55 % of surgical care delivered in some LMICs is via charitable organizations; the financial contributions of this sector provides valuable insight into understanding financing priorities in global surgery.
  
  
  METHODS
  Databases of registered charitable organizations in five high-income nations (United States, United Kingdom, Canada, Australia, and New Zealand) were searched to identify organizations committed exclusively to surgery in LMICs and their financial data. For each organization, we categorized the surgical specialty and calculated revenues and expenditures. All foreign currency was converted to U.S. dollars based on historical yearly average conversion rates. All dollars were adjusted for inflation by converting to 2014 U.S. dollars.
  
  
  RESULTS
  One hundred sixty organizations representing 15 specialties were identified. Adjusting for inflation, in 2014 U.S. dollars (US$), total aggregated revenue over the years 2008-2013 was $3·4 billion and total aggregated expenses were $3·1 billion. Twenty-eight ophthalmology organizations accounted for 45 % of revenue and 49 % of expenses. Fifteen cleft lip/palate organizations totaled 26 % of both revenue and expenses. The remaining 117 organizations, representing a variety of specialties, accounted for 29 % of revenue and 25 % of expenses. In comparison, from 2008 to 2013, charitable organizations provided nearly $27 billion for global health, meaning an estimated 11.5 % went towards surgery.
  
  
  CONCLUSIONS
  Charitable organizations that exclusively provide surgery in LMICs primarily focus on elective surgeries, which cover many subspecialties, and often fill deep gaps in care. The largest funding flows are directed at ophthalmology, followed by cleft lip and palate surgery. Despite the number of contributing organizations, there is a clear need for improvement and increased transparency in tracking of funds to global surgery via charitable organizations.
authors.affiliation: Department of Surgery, University of Utah, Salt Lake City, UT USA ; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA USA ; Tidziwe Center, UNC Project Malawi, Privae Bag A-104, Lilongwe, Malawi.
authors.forename: Lily
authors.identifier: 0000-0001-8674-7655
authors.initials: L
authors.lastname: Gutnik
authors.affiliation: Duke Global Health Institute, Duke University, Durham, NC USA.
authors.forename: Gavin
authors.initials: G
authors.lastname: Yamey
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA USA ; Department of Surgery, Brigham and Women's Hospital, Boston, MA USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Riviello
authors.affiliation: Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA ; Department of Plastic Surgery, Boston Children's Hospital, Boston, MA USA.
authors.forename: John G
authors.initials: JG
authors.lastname: Meara
authors.affiliation: King's Centre for Global Health, King's Health Partners, King's College London, London, England, UK.
authors.forename: Anna J
authors.initials: AJ
authors.lastname: Dare
authors.affiliation: Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA ; Harvard University Interfaculty Initiative in Health Policy, Boston, 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.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Shrime
keywords: Economics; Finance; Global health; Surgery