Non-Governmental Organizations Delivering Global Cardiac Surgical Care: A Quantitative Impact Assessment

Vervoort, Dominique; Guetter, Camila Roginski; Munyaneza, F.; Trager, Lena; Argaw, Salem; Abraham, Peter; Dayan, Víctor

doi:10.1053/j.semtcvs.2021.08.010

Cited by 20 publications

(12 citation statements)

References 10 publications

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“…Trust and personal friendships are often the strongest, and sometimes the only, enabler of local empowerment and inclusivity, catalysing the effective transfer of clinical acumen and long-term programme success. Finally, literature has highlighted the duplication and fragmentation of service that can often arise in global surgical efforts 36 37. The use of robust needs’ assessments and the collaboration with organisations already on-the-ground when starting out in global surgery, as identified by the stakeholders interviewed in this study, may be a potential solution to this challenge.…”

Section: Discussionmentioning

confidence: 97%

“…Finally, literature has highlighted the duplication and fragmentation of service that can often arise in global surgical efforts. 36 37 The use of robust needs’ assessments and the collaboration with organisations already on-the-ground when starting out in global surgery, as identified by the stakeholders interviewed in this study, may be a potential solution to this challenge.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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ObjectivesThis qualitative study aimed to explore the perspectives of Canadian global surgeons with experience developing surgical education partnerships with low- and middle-income countries (LMICs) for the purpose of identifying factors for success.DesignA purposive sample of leaders from global surgery programmes at Canadian Faculties of Medicine participated in virtual semi-structured interviews. A six-phase thematic analysis was performed using a constructivist lens on verbatim transcripts by three independent researchers. Key factors for success were thematically collated with constant comparison and inter-investigator triangulation in NVivo software until theoretical saturation was reached.ParticipantsFifteen surgeons, representing 11 subspecialties at 6 Canadian academic institutions and a combined experience across 6 continents, were interviewed between January and June 2022.ResultsFour facilitators for success of global surgery training programmes were identified, with a strong undertone of relationship-building permeating all subthemes: (1) facilitative skill sets and infrastructure, (2) longitudinal engagement, (3) local ownership and (4) interpersonal humility. Participants defined facilitative skill sets to include demonstrated surgical competence and facilitative infrastructure to include pre-existing local networks, language congruency, sustainable funding and support from external organisations. They perceived longitudinal engagement as spanning multiple trips, enabled by strong personal motivation and arrangements at their home institutions. Ownership of projects by local champions, including in research output, was noted as key to preventing brain drain and catalysing a ripple effect of surgical trainees. Finally, interviewees emphasised interpersonal humility as being crucial to decolonising the institution of global surgery with cultural competence, reflexivity and sustainability.ConclusionsThe interviewed surgeons perceived strong cross-cultural relationships as fundamental to all other dimensions of success when working in low-resource capacity-building. While this study presents a comprehensive Canadian perspective informed by high-profile leadership in global surgery, a parallel study highlighting LMIC-partners’ perspectives will be critical to a more complete understanding of programme success.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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“…Lastly, Zheleva highlights the important role of NGOs in helping expand global cardiovascular care (36). Previous data suggested that 86 NGOs are active in global cardiac surgery delivery, of which most (94.2%, N=81) are involved with pediatric and congenital heart surgery (37). Although fly-in-fly-out missions were traditionally a major focus of NGOs, the lack of local continuity of care (e.g., patient follow-up) and capacity-building (e.g., empowering local teams) resulted in more sustainable efforts, including bilateral and longitudinal partnerships between programs and capacity-building initiatives.…”

Section: Optimizing Cardiovascular Healthcare Deliverymentioning

confidence: 99%

Addressing Global Disparities in Pediatric and Congenital Cardiac Care: introduction to the special series

Vervoort¹,

Cardarelli²

2023

AME Surg J

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Over one million children are born with congenital heart disease (CHD) each year around the world (1). Approximately one in two children with CHD will require surgical or interventional care at least once in their lifetime (2), whereas one in five will need an intervention to survive to their first birthday (3). In addition, rheumatic heart disease (RHD) represents the most common acquired cardiovascular disease among children and adolescents (4). RHD is a disease of poverty largely eradicated in high-income countries, yet it continues to affect dozens of millions of people across low-and middle-income countries (LMICs) (4,5). Despite this considerable burden of cardiac surgical disease, over 90% of children in LMICs no access to cardiovascular care (6,7) resulting in more than 90% of deaths and disability-adjusted life-years (DALYs) in children to be "excess" (8).The current special series on "Addressing Global Disparities in Pediatric and Congenital Cardiac Care" provides a detailed overview of cardiovascular care for children living with cardiovascular diseases worldwide, with a particular emphasis on variable-resource contexts, where the disparities are greatest. Articles are briefly introduced in this editorial and include: (I) Addressing Global Disparities in Pediatric and Congenital Cardiac Care: introduction to the special series. (II) Narrative review in pediatric and congenital heart surgery in sub-Saharan Africa: challenges and opportunities in a new era. (III) "Regale una Vida" a successful social program for underprivileged children with congenital heart disease in a middle-income country. (IV) Pediatric cardiac NGOs: collaboration and coordination. (V) Fostering a sustainable pediatric cardiac workforce in the developing world during the current coronavirus disease 2019 (COVID-19) pandemic. (VI) Pediatric Cardiac Development Assistance in Conflict Zones. (VII) The road to regionalization in congenital heart surgery: a narrative review. (VIII) Generating political support for cardiac surgical care in resource-limited contexts: experience from Nepal.(IX) Ethics of resource allocation to congenital heart surgery in variable-resource contexts. This special series may expand upon and accelerate the contemporary global health discourse, which largely lacks the integration of pediatric and congenital cardiovascular care. Without an urgent recognition of the importance of pediatric and congenital cardiovascular care, the 2030 United Nations Sustainable Development Goal Agenda cannot and will not be attained (9). Global disparitiesRecent data confirm great disparities in the number of pediatric cardiac surgeons per million population. In high-income countries, there are approximately 9.51 pediatric cardiac surgeons per million under-15 population compared to only 0.07 per million in low-income countries (10). However, the number of pediatric cardiac surgeons managing neonates and infants with CHD is assumed to be far lower, although not exactly quantified (11). As such, Murala et al. (12). discuss opportunit...

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“… 10 A considerable part of the global cardiac surgical care is delivered by nongovernmental organizations (NGOs), which perform over 10,000 cardiac surgical procedures each year. 41 A majority (81/86, 94.2%) of NGOs are involved with PCHD care, of which most (56/86, 65.1%) are exclusively focused on paediatric populations. However, most efforts through NGOs are nonlocal and remain limited in long-term sustainability, which require locally driven health systems solutions.…”

Section: Service Deliverymentioning

confidence: 99%

“…Although international organizations play an important role in supporting PCHD programmes in LMICs, 41 it is essential to invest in local capacity development and expand domestic investments to ensure sustainable services. 43 , 60 , 61 Despite the 2001 commitment made by all African countries in the Abuja Declaration to allocate 15% of annual government budgets to health care, nearly all countries have not met this target.…”

Section: Financingmentioning

confidence: 99%

Global Access to Comprehensive Care for Paediatric and Congenital Heart Disease

Vervoort,

Jin,

Edwin

et al. 2023

CJC Pediatric and Congenital Heart Disease

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Non-Governmental Organizations Delivering Global Cardiac Surgical Care: A Quantitative Impact Assessment

Cited by 20 publications

References 10 publications

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

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

Addressing Global Disparities in Pediatric and Congenital Cardiac Care: introduction to the special series

Global Access to Comprehensive Care for Paediatric and Congenital Heart Disease

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