Children at the heart of global surgery: children’s surgery in low- and middle-income countries

Abstract

Global child health is incomplete without the inclusion of global children’s surgery. Despite recent advances, many challenges exist in the field of global children’s surgery. Currently, an estimated 1.7 billion children lack access to safe, affordable, and timely surgery and anesthesia care globally. The aim of this review article was to discuss challenges and achievements in the field of global children’s surgery with a focus on workforce capacity, training and education, research, and financing. Almost a half of the population in many low- and middle-income countries (LMICs) is comprised of children under the age of 15. Even then, many LMICs suffer from severe workforce shortages, inadequacy of strong medical schools and children’s surgery training programs, and limited research capacity and funding dedicated to children’s surgery. Specifically, Malawi and Pakistan were reported to have a pediatric surgical workforce density (PSWD) of only 0.17 and 0.4 children’s surgeons per million children, respectively. Unavailability of robust research and educational programs within an individual’s home country has also been seen to motivate students and trainees to pursue specialized children’s surgical training abroad, which further exacerbates the ongoing workforce deficiencies. Recently, the introduction of the Global Initiative for Children’s Surgery has played a pivotal role in advancing the field of children’s surgery, by promoting stronger LMIC representation and inclusion in advocacy, research, and education. In addition, successful international research collaborations, including the GlobalPaedSurg and GlobalSurg; training courses and programs; organizational efforts to improve infrastructure and service delivery, including KidsOR; and inclusion of children’s surgery into the national surgical, obstetrics, and anesthesia plans (NSOAPs) underscore the importance of engaging LMIC colleagues and stakeholders to achieve the seemingly audacious but reasonable goal of making sure that every child has access to safe surgical care.