Specialized Surgical Platforms

Excerpt

A large fraction of the burden of disease comprises conditions that are potentially amenable to surgical intervention (chapters 1 and 2) (Bickler and others 2015; Mock and others 2015). The proportion is higher in low- and middle-income countries (LMICs) (Shrime, Sleemi, and Ravilla 2014). Because of difficulties in access to surgical care—often due to issues of cost, transportation, infrastructure, and a lack of providers (Chao and others 2012; Ilbawi, Einterz, and Nkusu 2013; Knowlton and others 2013; Linden and others 2012)—this surgical burden is sometimes borne by the international charitable sector.

Historically, first-level hospitals in LMICs have tended primarily to treat conditions associated with a low disability-adjusted life year (DALY) burden. These hospitals have done so with a high loss to follow-up; patients scheduled for surgeries often do not return for their operations (Ilbawi, Einterz, and Nkusu 2013), especially as the complexity and up-front costs of the surgeries increase. Meanwhile, charitable sector involvement has grown rapidly: the charitable sector in the United States, which includes many international charitable surgical organizations, has grown at a pace exceeding the growth of gross domestic product by 20 percent and is currently larger than its counterpart agriculture, construction, transportation, and utilities sectors (Casey 2007). Médecins Sans Frontières (also known as Doctors Without Borders) alone has an annual budget of more than US$700 million, much of which comes from private funders (McCoy, Chand, and Sridhar 2010). This review focuses specifically on the charitable sector’s role in the delivery of surgical care in LMICs.

This chapter uses the World Health Organization’s (WHO’s) six geographical regions: African Region, Region of the Americas, South-East Asia Region, European Region, Eastern Mediterranean Region, and Western Pacific Region.