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Qin R, Alayande B, Okolo I, Khanyola J, Jumbam DT, Koea J, Boatin AA, Lugobe HM, Bump J. Colonisation and its aftermath: reimagining global surgery. BMJ Glob Health 2024; 9:e014173. [PMID: 38176746 PMCID: PMC10773343 DOI: 10.1136/bmjgh-2023-014173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 11/24/2023] [Indexed: 01/06/2024] Open
Abstract
Coloniality in global health manifests as systemic inequalities, not based on merit, that benefit one group at the expense of another. Global surgery seeks to advance equity by inserting surgery into the global health agenda; however, it inherits the biases in global health. As a diverse group of global surgery practitioners, we aimed to examine inequities in global surgery. Using a structured, iterative, group Delphi consensus-building process drawing on the literature and our lived experiences, we identified five categories of non-merit inequalities in global surgery. These include Western epistemology, geographies of inequity, unequal participation, resource extraction, and asymmetric power and control. We observed that global surgery is dominated by Western biomedicine, characterised by the lack of interprofessional and interspecialty collaboration, incorporation of Indigenous medical systems, and social, cultural, and environmental contexts. Global surgery is Western-centric and exclusive, with a unidirectional flow of personnel from the Global North to the Global South. There is unequal participation by location (Global South), gender (female), specialty (obstetrics and anaesthesia) and profession ('non-specialists', non-clinicians, patients and communities). Benefits, such as funding, authorship and education, mostly flow towards the Global North. Institutions in the Global North have disproportionate control over priority setting, knowledge production, funding and standards creation. This naturalises inequities and masks upstream resource extraction. Guided by these five categories, we concluded that shifting global surgery towards equity entails building inclusive, pluralist, polycentric models of surgical care by providers who represent the community, with resource controlled and governance driven by communities in each setting.
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Affiliation(s)
- Rennie Qin
- Department of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Barnabas Alayande
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Gasabo, Rwanda
- Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Isioma Okolo
- Department of Obstetrics and Gynaecology, NHS Slothian, Edinburgh, UK
| | - Judy Khanyola
- Center for Nursing and Midwifery, University of Global Health Equity, Kigali, Gasabo, Rwanda
| | - Desmond Tanko Jumbam
- Department of Health Policy and Advocacy, Operation Smile, Virginia Beach, Virginia, USA
| | - Jonathan Koea
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Adeline A Boatin
- Department of Obstetrics & Gynecology and Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Henry Mark Lugobe
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology Faculty of Medicine, Mbarara, Uganda
| | - Jesse Bump
- Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Bergen Center for Ethics and Priority Setting, University of Bergen, Bergen, Norway
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Jumbam DT, Touray S, Totimeh T. The role of journals and journal editors in advancing global health research equity. Anaesthesia 2021; 77:243-247. [PMID: 34881438 DOI: 10.1111/anae.15638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 11/28/2022]
Affiliation(s)
- D T Jumbam
- Department of Policy and Advocacy, Operation Smile, Virginia Beach, VA, USA.,Operation Smile Ghana, Accra, Ghana
| | - S Touray
- Permian Health, Bakau Newtown, The Gambia
| | - T Totimeh
- University of Ghana Medical Center, Accra, Ghana
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Amoako E, Jumbam DT, Bediako Y. Unseen and unheard: African children with cancer are consistently excluded from clinical trials. BMJ Glob Health 2021; 6:bmjgh-2020-004750. [PMID: 33472839 PMCID: PMC7818831 DOI: 10.1136/bmjgh-2020-004750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Emmanuella Amoako
- Department of Paediatrics and Child Health, Cape Coast Teaching Hospital, Cape Coast, Ghana .,Department of Paediatrics and Child Health, University of Cape Coast, Cape Coast, Ghana.,Yemaachi Biotechnology, Accra, Ghana
| | | | - Yaw Bediako
- Yemaachi Biotechnology, Accra, Ghana.,West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Accra, Ghana
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Abimbola S, Asthana S, Montenegro C, Guinto RR, Jumbam DT, Louskieter L, Kabubei KM, Munshi S, Muraya K, Okumu F, Saha S, Saluja D, Pai M. Addressing power asymmetries in global health: Imperatives in the wake of the COVID-19 pandemic. PLoS Med 2021; 18:e1003604. [PMID: 33886540 PMCID: PMC8101997 DOI: 10.1371/journal.pmed.1003604] [Citation(s) in RCA: 109] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 05/06/2021] [Indexed: 02/07/2023] Open
Abstract
Seye Abimbola and co-authors argue for a transformation in global health research and practice in the post-COVID-19 world.
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Affiliation(s)
- Seye Abimbola
- School of Public Health, University of Sydney, Sydney, Australia
| | | | | | - Renzo R. Guinto
- PH Lab & Planetary and Global Health Program, St. Luke’s Medical Center College of Medicine—William H. Quasha Memorial, Manila, Philippines
| | | | | | | | - Shehnaz Munshi
- University of the Witwatersrand, Johannesburg, South Africa
| | - Kui Muraya
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | | | - Senjuti Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | | | - Madhukar Pai
- School of Population and Global Health, McGill University, Montreal, Canada
- * E-mail:
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Reddy CL, Peters AW, Jumbam DT, Caddell L, Alkire BC, Meara JG, Atun R. Innovative financing to fund surgical systems and expand surgical care in low-income and middle-income countries. BMJ Glob Health 2020; 5:e002375. [PMID: 32546586 PMCID: PMC7299051 DOI: 10.1136/bmjgh-2020-002375] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 02/02/2023] Open
Abstract
Strong surgical systems are necessary to prevent premature death and avoidable disability from surgical conditions. The epidemiological transition, which has led to a rising burden of non-communicable diseases and injuries worldwide, will increase the demand for surgical assessment and care as a definitive healthcare intervention. Yet, 5 billion people lack access to timely, affordable and safe surgical and anaesthesia care, with the unmet demand affecting predominantly low-income and middle-income countries (LMICs). Rapid surgical care scale-up is required in LMICs to strengthen health system capabilities, but adequate financing for this expansion is lacking. This article explores the critical role of innovative financing in scaling up surgical care in LMICs. We locate surgical system financing by using a modified fiscal space analysis. Through an analysis of published studies and case studies on recent trends in the financing of global health systems, we provide a conceptual framework that could assist policy-makers in health systems to develop innovative financing strategies to mobilise additional investments for scale-up of surgical care in LMICs. This is the first time such an analysis has been applied to the funding of surgical care. Innovative financing in global surgery is an untapped potential funding source for expanding fiscal space for health systems and financing scale-up of surgical care in LMICs.
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Affiliation(s)
- Ché L Reddy
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Alexander W Peters
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Desmond Tanko Jumbam
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Luke Caddell
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Blake C Alkire
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Center for Global Surgery Evaluation, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Department of Global Health Equity, Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Rifat Atun
- Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Kanmounye US, Jumbam DT, Endomba FT, Tochie JN, Mbonda AN, Ghomsi NC, Nkeck JR, Nguembu SR, Temgoua M. Advancing medical research in sub-Saharan Africa: barriers, facilitators, and proposed solutions. PAMJ-CM 2020. [DOI: 10.11604/pamj-cm.2020.3.83.23716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Kanmounye US, Tochie JN, Temgoua M, Mbonda AN, Endomba FT, Nkeck JR, Wafo C, Ntock FN, Jumbam DT. Barriers and facilitators of research in Cameroon (Part II) - an e-survey of medical students. PAMJ-CM 2020. [DOI: 10.11604/pamj-cm.2020.3.179.24649] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Kanmounye US, Tochie JN, Temgoua M, Mbonda AN, Endomba FT, Nkeck JR, Wafo CR, Ntock FN, Jumbam DT. Barriers and facilitators of research in Cameroon (Part I) - an e-survey of physicians. PAMJ-CM 2020. [DOI: 10.11604/pamj-cm.2020.4.58.24608] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Roa L, Jumbam DT, Makasa E, Meara JG. Global surgery and the sustainable development goals. Br J Surg 2019; 106:e44-e52. [DOI: 10.1002/bjs.11044] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 10/10/2018] [Indexed: 12/13/2022]
Abstract
Abstract
Background
The field of global surgery has gained significant recent momentum, catalysed by the 2015 publication of the Lancet Commission on Global Surgery, Disease Control Priorities 3 and World Health Assembly resolution 68.15. These reports characterized the global burden of disease amenable to surgical care, called for global investment in surgical systems, and recognized surgery and anaesthesia as essential components of universal health coverage.
Methods
A strategy proposed to strengthen surgical care is the development of national surgical, obstetric and anaesthesia plans (NSOAPs). This review examined how NSOAPs could contribute to the achievement of sustainable development goals (SDGs) 1, 3, 5, 8, 9, 10, 16 and 17 by 2030, focusing on their potential impact on the healthcare systems in Ethiopia, Tanzania and Zambia.
Results
Due to the cross-cutting nature of surgery, obstetrics and anaesthesia, investing in these services will escalate progress to achieve gender equality, economic growth and infrastructure development. Universal health coverage will not be achieved without addressing the financial ramifications to the poor of seeking and receiving surgical care. NSOAPs provide a strategic framework and a data collection platform for evidence-based policy-making, accountability and implementation guidance.
Conclusion
The development and implementation of data-driven NSOAPs should be recognized as a powerful road map to accelerate achievement of the SDGs by 2030.
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Affiliation(s)
- L Roa
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Alberta, Canada
| | - D T Jumbam
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - E Makasa
- Cabinet Office, Lusaka, Republic of Zambia
- Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences of the University of Witwatersrand, Johannesburg, South Africa
| | - J G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
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