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BMJ Open. 2015 Nov 9;5(11):e008780. doi: 10.1136/bmjopen-2015-008780.

Funding allocation to surgery in low and middle-income countries: a retrospective analysis of contributions from the USA.

Author information

1
Department of Surgery, Montefiore Medical Center, Bronx, New York, USA Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA UNC Project Malawi, Lilongwe, Malawi.
2
Institute of Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.
3
Department of Global Health, King's Centre for Global Health, King's Health Partners & King's College London, London, UK.
4
Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA.
5
Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.
6
Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA Boston Children's Hospital, Boston, Massachusetts, USA.
7
Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.
8
Duke Global Health Institute, Duke University, Durham NC, USA Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA.

Erratum in

Abstract

OBJECTIVE:

The funds available for global surgical delivery, capacity building and research are unknown and presumed to be low. Meanwhile, conditions amenable to surgery are estimated to account for nearly 30% of the global burden of disease. We describe funds given to these efforts from the USA, the world's largest donor nation.

DESIGN:

Retrospective database review. US Agency for International Development (USAID), National Institute of Health (NIH), Foundation Center and registered US charitable organisations were searched for financial data on any organisation giving exclusively to surgical care in low and middle income countries (LMICs). For USAID, NIH and Foundation Center all available data for all years were included. The five recent years of financial data per charitable organisation were included. All nominal dollars were adjusted for inflation by converting to 2014 US dollars.

SETTING:

USA.

PARTICIPANTS:

USAID, NIH, Foundation Center, Charitable Organisations.

PRIMARY AND SECONDARY OUTCOME MEASURES:

Cumulative funds appropriated to global surgery.

RESULTS:

22 NIH funded projects (totalling $31.3 million) were identified, primarily related to injury and trauma. Six relevant USAID projects were identified-all obstetric fistula care totalling $438 million. A total of $105 million was given to universities and charitable organisations by US foundations for 12 different surgical specialties. 95 US charitable organisations representing 14 specialties totalled revenue of $2.67 billion and expenditure of $2.5 billion.

CONCLUSIONS AND RELEVANCE:

Current funding flows to surgical care in LMICs are poorly understood. US funding predominantly comes from private charitable organisations, is often narrowly focused and does not always reflect local needs or support capacity building. Improving surgical care, and embedding it within national health systems in LMICs, will likely require greater financial investment. Tracking funds targeting surgery helps to quantify and clarify current investments and funding gaps, ensures resources materialise from promises and promotes transparency within global health financing.

KEYWORDS:

HEALTH ECONOMICS; PUBLIC HEALTH; SURGERY

PMID:
26553831
PMCID:
PMC4654347
DOI:
10.1136/bmjopen-2015-008780
[Indexed for MEDLINE]
Free PMC Article

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