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

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Date
2015-11-09
Authors
Gutnik, Lily
Dieleman, Joseph
Dare, Anna J
Ramos, Margarita S
Riviello, Robert
Meara, John G
Yamey, Gavin
Shrime, Mark G
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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.
Type
Journal article
Subject
Humans
Surgical Procedures, Operative
Retrospective Studies
Developing Countries
Charities
Health Expenditures
Financing, Organized
Financing, Government
United States
Healthcare Financing
Permalink
https://hdl.handle.net/10161/21315
Published Version (Please cite this version)
10.1136/bmjopen-2015-008780
Publication Info
Gutnik, Lily; Dieleman, Joseph; Dare, Anna J; Ramos, Margarita S; Riviello, Robert; Meara, John G; ... Shrime, Mark G (2015). Funding allocation to surgery in low and middle-income countries: a retrospective analysis of contributions from the USA. BMJ open, 5(11). pp. e008780. 10.1136/bmjopen-2015-008780. Retrieved from https://hdl.handle.net/10161/21315.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
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Scholars@Duke

Gutnik

Lily Gutnik

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Yamey

Gavin Mark Yamey

Hymowitz Family Professor of the Practice in Global Health
Gavin Yamey, MD, MPH, trained in clinical medicine at Oxford University and University College London, medical journalism and editing at the BMJ and public health at the London School of Hygiene and Tropical Medicine. He was Deputy Editor of the Western Journal of Medicine, Assistant Editor at the BMJ, a founding Senior Editor of PLOS Medicine, and the Principal Investigator on a $1.1 million grant from the Bill & Melinda Gates Foundation to support the launch of PLOS Neglected Tropical D
Alphabetical list of authors with Scholars@Duke profiles.
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