Global pediatric surgery and anesthesia inequities: how do we have a global effort?.

Niconchuck and Newton open their review with some long-known but unsettling statistics:

  1. 5 billion people worldwide lack access to safe surgery
  2. Paediatric perioperative mortality may be 100 times higher in low-resource than high-resource settings
  3. At an individual level, delays in access to surgical care can add 8.4 years of disability to a child’s life

The authors also highlight ongoing funding and research inequities, more than three decades after it was recognised that only 10% of health research resources were directed to low-middle income countries (LMICs), despite these countries accounting for more than 90% of preventable global mortality.

Research attribution remains equally uneven; authors from high income countries (HICs) are far more likely to be named first and last in collaborative efforts, even when the research itself occurs in the LMIC, whose researchers may not even be credited at all.

Ironically, this effect is most clear in editorials on ethics in global surgery, of which this paper is an excellent example, a fact the authors (both of a HIC) are good enough to acknowledge.

How then can we address these longstanding issues?

It is clear that the short-term surgical project model so beloved of advertisers and donors does not generate meaningful sustainable change, and moreover is vulnerable to the effects of global pandemics.

Instead, the authors propose education, partnership and collaboration between LMICs and HICs to create self-sustaining in-country training models for current and future LMIC providers.

Importantly, these endeavours need be informed by priorities identified by LMIC stakeholders (not presumed by HICs) and require a long-term commitment from both.  The review concludes with a suite of five consensus key indicators in global surgery, anaesthesia and obstetrics (covering access to care, workforce, volume, outcome and expenditure), albeit again with a largely HIC authorship.

In summary, this is an interesting, wide-ranging and well-meaning call-to-arms and review of the current literature, but yields little that is concrete.

The list of references is comprehensive, with useful summaries provided for interested readers.

Reviewed by Dr Jon Stacey