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Improving Access to Pediatric Surgery in LMICs Through Capacity-Building: A Systematic Review.

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Capacity-strengthening projects improve pediatric surgical care in low- and middle-income countries (LMICs). This review identifies effective methods and barriers to implementing these vital interventions for children needing surgery.

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Area of Science:

  • Global Health
  • Pediatric Surgery
  • Health Systems Strengthening

Background:

  • Pediatric surgical conditions cause significant morbidity and mortality in low- and middle-income countries (LMICs).
  • Access to pediatric surgical care is limited in LMICs due to surgeon shortages, inadequate training, and financial constraints.
  • There is a shift towards capacity-strengthening initiatives to enhance local healthcare resources and skills.

Purpose of the Study:

  • To systematically review and synthesize the literature on capacity-strengthening projects in pediatric surgery within LMICs.
  • To identify the methods, outcomes, limitations, and barriers associated with these interventions.

Main Methods:

  • Searched MEDLINE, EMBASE, Cochrane, and Web of Science databases until May 2023.
  • Included studies focused on pediatric surgery patients, capacity-strengthening interventions, improved access (Lancet Commission on Global Surgery Indicators), and were conducted in World Bank-defined LMICs.
  • Two independent reviewers performed study screening and data extraction.

Main Results:

  • Eighty studies met the inclusion criteria, detailing interventions in 69 LMICs using 19 distinct capacity-strengthening methods.
  • Common methods included international surgical visits, training programs, partnerships, mobile clinics, infrastructure enhancements, and telemedicine.
  • These interventions facilitated 1,357,077 pediatric surgeries, with notable successes in training local providers and improving rural access.

Conclusions:

  • The review highlights successful methods for implementing pediatric surgical capacity-strengthening interventions in LMICs, alongside identified challenges.
  • Future research should prioritize reporting ethical considerations and quantitative outcomes to rigorously assess intervention effectiveness.