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World J Surg. 2015 Jan;39(1):10-20. doi: 10.1007/s00268-014-2516-0.

Charitable platforms in global surgery: a systematic review of their effectiveness, cost-effectiveness, sustainability, and role training.

Author information

1
Harvard Interfaculty Initiative in Health Policy, 14 Story Street, 4th Floor, Cambridge, MA, 02138, USA, shrime@gmail.com.

Abstract

OBJECTIVE:

This study was designed to propose a classification scheme for platforms of surgical delivery in low- and middle-income countries (LMICs) and to review the literature documenting their effectiveness, cost-effectiveness, sustainability, and role in training. Approximately 28 % of the global burden of disease is surgical. In LMICs, much of this burden is borne by a rapidly growing international charitable sector, in fragmented platforms ranging from short-term trips to specialized hospitals. Systematic reviews of these platforms, across regions and across disease conditions, have not been performed.

METHODS:

A systematic review of MEDLINE and EMBASE databases was performed from 1960 to 2013. Inclusion and exclusion criteria were defined a priori. Bibliographies of retrieved studies were searched by hand. Of the 8,854 publications retrieved, 104 were included.

RESULTS:

Surgery by international charitable organizations is delivered under two, specialized hospitals and temporary platforms. Among the latter, short-term surgical missions were the most common and appeared beneficial when no other option was available. Compared to other platforms, however, worse results and a lack of cost-effectiveness curtailed their role. Self-contained temporary platforms that did not rely on local infrastructure showed promise, based on very few studies. Specialized hospitals provided effective treatment and appeared sustainable; cost-effectiveness evidence was limited.

CONCLUSIONS:

Because the charitable sector delivers surgery in vastly divergent ways, systematic review of these platforms has been difficult. This paper provides a framework from which to study these platforms for surgery in LMICs. Given the available evidence, self-contained temporary platforms and specialized surgical centers appear to provide more effective and cost-effective care than short-term surgical mission trips, except when no other delivery platform exists.

PMID:
24682278
PMCID:
PMC4179995
DOI:
10.1007/s00268-014-2516-0
[Indexed for MEDLINE]
Free PMC Article

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