A systematic review of global surgery partnerships and a proposed framework for sustainability

Abstract

Background: Building surgical capacity through global surgery partnerships (GSPs) between high and low- and middle-income countries (LMICs) is a rising global health focus. Our aim was to conduct a systematic review to characterize strategies employed by GSPs to build capacity and promote sustainability and to propose a novel reproducible model for sustainability. Methods: We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We searched PubMed, EMBASE, Medline and African Journals Online to identify all peer-reviewed articles published between 2000 and 2016 that described GSPs between partners from the United States or Canada or both and partners from LMICs. We excluded papers that described nonsurgical GSPs, unilateral GSPs (e.g., humanitarian missions) or military initiatives. Descriptive features were analyzed, with a focus on attributes that promote sustainability. We then proposed criteria for sustainability on the basis of the themes that emerged from our review. Results: Our search retrieved 3580 abstracts, which were then independently reviewed by 4 authors. A total of 128 papers (3.6%) met the inclusion criteria. They described GSPs in 68 countries on 5 continents. Among the GSPs, 21.9% demonstrated community engagement and 51.6% included multidisciplinary collaboration. Surgical training or education was provided in 81.3% of GSPs. Although 64.8% of GSPs collected data, only 53.1% reported project-related outcomes. A total of 55.5% had bilateral authorship for publications, and 28.9% had multisource funding. Only 1 GSP fulfilled all 6 of our criteria for sustainability. Conclusion: In this systematic review we identified 6 pillars that are indicators of sustainability: community engagement, multidisciplinary collaboration, education and training, outcomes reporting, bilateral authorship and multisource funding. We propose that future GSPs should build on a foundation of bilateral ideas and expertise exchange, that they should have defined and measurable objectives, that they should engage in continuous evaluation of program outcomes and that they should take a thoughtful and transparent approach to sustained capacity building.

Partnering to build surgical capacity in low-resource settings: a qualitative study of Canadian global surgeons

“…10 11 Yet, whereas the content of any singular global surgery project has varied, a systematic review of partnerships between North American and LMIC institutions found that over 81% of these projects included a surgical education component. 12 Other partnerships have included help with accreditation bodies, technology acquisition, research capacity, library access and human resource development. 13 Such a focus on surgical education is prudent; it is well known that physicians tend to stay where they train.…”

“…Indeed, definitions of such have varied over the years, with one group framing it as ‘the enterprise of providing improved and equitable surgical care to the world’s population, with its core tenets as the issues of need, access and quality’ and another author characterising it far more comprehensively as the ‘area for study, research, practice, and advocacy that places priority on improving health outcomes and achieving health equity for all people worldwide who are affected by surgical conditions or have a need for surgical care’ 10 11. Yet, whereas the content of any singular global surgery project has varied, a systematic review of partnerships between North American and LMIC institutions found that over 81% of these projects included a surgical education component 12. Other partnerships have included help with accreditation bodies, technology acquisition, research capacity, library access and human resource development 13…”

“…There remains limited consensus on the best way to design and implement surgical training partnerships. Thus, many projects face challenges of hampered sustainability, pseudo-colonial exploitation and unreliable funding models 12 19. With significant heterogeneity in project design and outcomes hindering a quantitative meta-analysis, this project aims to use a qualitative approach to consolidate experiences from global surgeons across Canada to characterise key factors for success behind education-based surgical capacity-building efforts.…”

Global Surgery Education and Training Programmes—a Scoping Review and Taxonomy

“…It is also a key focus of international surgical partnerships. In a systematic review of global surgery partnerships between North American and LMIC institutions, Jedrzejko et al [8] find that 81% of partnerships contain a surgical education or training component.…”

Global Health Equity: A Vision for Engaging Thoracic Surgeons

“…5 Successful engagements range from short-term missions to long-term partnerships, though always with an emphasis on respectful and meaningful collaboration with the local health system and workforce. 6 These partnerships have led to important gains influencing policy and strategy at national and international levels, which are necessary to promote costeffectiveness and sustainability. 7 Advances in technology have led to a revolution in the approach to surgical capacity building globally.…”