Funding allocation to surgery in low and middle-income countries: a retrospective analysis of contributions from the USA.
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 articleSubject
HumansSurgical Procedures, Operative
Retrospective Studies
Developing Countries
Charities
Health Expenditures
Financing, Organized
Financing, Government
United States
Healthcare Financing
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https://hdl.handle.net/10161/21315Published Version (Please cite this version)
10.1136/bmjopen-2015-008780Publication 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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Show full item recordScholars@Duke
Lily Gutnik
Affiliate
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
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