Global Initiative for Children’s Surgery: A Model of Global Collaboration to Advance the Surgical Care of Children

Abstract

Background Recommendations by the Lancet Commission on Global Surgery regarding surgical care in low-and middle-income countries (LMICs) require development to address the needs of children. The Global Initiative for Children's Surgery (GICS) was founded in 2016 to identify solutions to problems in children's surgery by utilizing the expertise of practitioners from around the world. This report details this unique process and underlying principles. Methods Three global meetings convened providers of surgical services for children. Through working group meetings, participants reviewed the status of global children's surgery to develop priorities and identify necessary resources for implementation. Working groups were formed under LMIC leadership to address specific priorities. By creating networking opportunities, GICS has promoted the development of LMIC-LMIC and HIC-LMIC partnerships. Results GICS members identified priorities for children's surgical care within four pillars: infrastructure, service delivery, training and research. Guidelines for provision of care at every healthcare level based on these pillars were created. Seventeen subspecialty, LMIC chaired working groups developed the Optimal Resources for Children's Surgery (OReCS) document. The guidelines are stratified by subspecialty and level of health care: primary health center, first-, second-and third-level hospitals, and the national children's hospital. The OReCS document delineates the personnel, equipment, facilities, procedures, training, research and quality improvement components at all levels of care. Conclusion Worldwide collaboration with leadership by providers from LMICs holds the promise of improving children's surgical care. GICS will continue to evolve in order to achieve the vision of safe, affordable, timely surgical care for all children. Defining the need Surgical burden of disease Since the conclusion of the United Nations' Millennium Development Goals (MDGs) and through the ongoing work toward Sustainable Development Goals (SDGs), tremendous progress has been made toward reducing childhood mortality [1, 2]. However, the care of children with surgical diseases remains an underappreciated and underfunded area in health care, despite congenital Collaborating members are listed in the Acknowledgments.

Bedside surgery in the newborn infants: survey of the Italian society of pediatric surgery

“…At the same time, the regular activity of the NICU must not be disrupted by surgery [1]. A NICU dedicated surgical team enables optimal reach and utilization of resources, but solutions for optimizing children's surgical care remain under debate worldwide [23,24]. So far there are no Italian recommendations for bedside surgery in the NICU, and more than 50% of the centers do not consult specialist literature sources to support the practice of NICU surgical intervention.…”

“…So far there are no Italian recommendations for bedside surgery in the NICU, and more than 50% of the centers do not consult specialist literature sources to support the practice of NICU surgical intervention. In general, because the feasibility and safety of NICU bedside surgery are well documented [8][9][10][11][12][13][14][15], and the Lancet Commission on Global Surgery [24] on surgical care encourages the introduction of this new therapeutic approach to address the needs of children, no special permission is required. The results of this Survey may be used to optimize the organization of infrastructure, service delivery, training and research, however the development of specific National guidelines may help in the national spread and standardization of NICU bedside surgery.…”

“…The results of this Survey may be used to optimize the organization of infrastructure, service delivery, training and research, however the development of specific National guidelines may help in the national spread and standardization of NICU bedside surgery. Such guidelines should include an optimal National resources document outlining the personnel, equipment, facilities, procedures, training, research and quality improvement components necessary at all levels of care [24]. Additionally, a surgical safety checklist could be adopted to improve teamwork, communication and adherence to procedural steps and also as a useful learning tool to help junior doctors perform invasive procedures in the NICU [1,2].…”

Health and Disease among Primary School Children: A Snapshot from Rural Bangladesh

“…Recent research in LMICs suggested that capacity building, scale up of children's surgical care, more implementation research, and ongoing advocacy are some of the most necessary factors to improve access to children's surgical care [36]. The global initiative for children's surgery (GICS) identified priorities for children's surgical care within four pillars: infrastructure, service delivery, training and research [1].…”

“…Although there has been tremendous development in the world at addressing health care issues over the last few decades, there are still disparities in health care among countries and among areas within countries. It has been estimated that one third of childhood deaths in the world are attributed to surgical conditions [1]. But the delivery of safe, effective surgical care to children is still a neglected area within global surgical efforts.…”