Global Surgical Ecosystems: A Need for Systems Strengthening

Area of Science:

• Global Health
• Health Systems Strengthening
• Surgical Care Delivery

Background:

• Surgery is increasingly recognized as essential for universal health coverage.
• Advocacy efforts have led to resolutions supporting surgical care integration into global health initiatives.
• Understanding the surgical environment as an ecosystem is critical for effective care delivery.

Purpose of the Study:

• To define the components of a functioning surgical ecosystem.
• To highlight the importance of a systems approach for scaling up surgical services.
• To emphasize the need for integrating various elements for sustainable quality standards.

Main Methods:

• Describing key components: administration, support staff, clinicians, and essential materials (anesthetics, sutures, instruments).
• Identifying integrated systems: facilities, utilities (electricity, plumbing, waste management), and laundry.
• Referencing World Health Organization (WHO) tools for situational analysis in district hospitals.

Main Results:

• A functioning surgical ecosystem requires a network of people, processes, and materials.
• Lack of any single component can hinder surgical care, particularly in low and middle-income countries (LMICs).
• WHO situational analyses and checklists aid in identifying deficiencies.

Conclusions:

• Siloed approaches are insufficient for addressing systemic challenges in surgical care.
• A holistic ecosystem approach is necessary for rapid scaling and sustaining quality standards.
• Engagement of local and global professional societies and advocacy organizations is vital.