Resources and advocacy

What is global surgery at the IGS?

At the Institute of Global Surgery (IGS), we define global surgery as follows: a field that aims to understand and address the impediments to the equitable provision of safe, affordable, and timely surgical, anesthetic, and obstetric care to people and to patients worldwide, through research, education, and international collaboration.

This definition has implications:

  1. By aiming to understand and reduce the impediments to care, we take a public health approach to surgical access. We are interested in addressing the why behind these barriers – identifying them through research and lowering them through our education and implementation programmes.
  2. By addressing a lack of access wherever it occurs, we do not limit our work to any particular region. We aim instead to work where the need and potential impact is greatest. Global surgery is not simply 'surgery over there', and populations within high-income countries may be an appropriate context for study and intervention. The current focus on sub-Saharan Africa and Asia is a result of the fact that the highest burden of disease and lowest access to care is in these regions.

Patient-centredness is easy to claim, harder to accomplish. At the IGS, we take a holistic view of patient-centredness.

We recognise that it is more than surgical volume, mortality, and morbidity. Patients care not only about receiving their surgery but about being able to do so in a way that does not impoverish them, that allows them to return to their pre-health-shock life, and that respects their autonomy.

They care about consent, about infrastructure that meets them where they are, about coordination and referral systems that help them navigate the system, and about access to care close to where they live.

We also recognise that the barriers that patients face are multifactorial. We recognise that the primary barriers reported by patients are demand-side: they are financial, cultural, social, and structural barriers.

We recognise that traditional beliefs play a significant, but understudied, role within the healthcare system, often at great cost to patients. Although cost is repeatedly cited as the highest barrier to care by patients, demand-side barriers as a whole limit their access. These demand-side barriers place a hard ceiling on the effectiveness of our training programmes.

Finally, we recognise that both providers and systems benefit from patient-centred care as well. If patients are happy, providers tend to work better and more effectively, and if traditional approaches to healthcare are be incorporated within the overall referral system, holistic patient outcomes are likely to improve.

The research and educational pillars of the IGS have come together through a shared focus on patient-centredness, a focus which sets us apart from much of the global surgery space. We grow this emphasis through deepening our focus on patient-centred structures and outcomes in both educational and research initiatives.

We believe that safe, affordable, and timely access to surgery can improve the whole patient - health, financial security, and (re-) integration into a community - so we incorporate these outcomes into our assessments.

We believe a comprehensive and coordinated global response to the surgical care crisis in low- and middle-income countries is required, and we wish to see increased political priority for surgical care.

Universal healthcare cannot be achieved without substantial investment in surgical care and we believe investment should be based on evidence of what works.

The following messages are drawn from our own research and experience, that of our partners, and evidence generated by the global surgery community:

  • Surgery is a team sport ­and investment is required across the entire surgical care workforce, including anaesthetists, technicians, nurses, obstetrician/gynaecologists and surgeons.
  • Training locally is vitally important to achieve high rates of surgical provider retention.
  • Where specialist surgeons are scarce, the role of the surgeon should include mentorship and supervision of other cadres of surgical provider.
  • Developing the surgical care workforce cannot be achieved without better engagement of women, encouraging more women to join the surgical care workforce, and attain leadership positions therein.

We are working to realise this future by:

  • Leveraging the respected voice of RCSI to highlight the surgical care crisis in Ireland; East, Central and Southern Africa; and worldwide.
  • Helping the voice of our partner organisations be heard on a global scale.
  • Engaging with national policymakers to ensure that our research answers questions relevant to national planning and policy and that this information is made available to policymakers.
  • Supporting efforts to bring the global surgery community together through active membership of the Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care (the G4 Alliance) and other initiatives.
  • Supporting Women in Surgery Africa, through the RCSI/COSECSA Collaboration Programme.

The world needs your support to advocate for global surgery. The G4 Alliance advocacy toolkit contains tools that everyone can use to get involved.

On the first Wednesday of the month at 2pm (IST), the IGS hosts the international Global Surgery Grand Rounds – a series of webinars with invited speakers who discuss different aspects of global surgery.

The aim of these Grand Rounds is widen the conversation and raise the profile of global surgery within the international development and global health space. Recordings of past Grand Rounds can be found on our YouTube channel.

Sign up to the IGS mailing list here to be informed of future Grand Rounds and other events relating to global surgery.