A framework for the monitoring and evaluation of international surgical initiatives in low- and middle-income countries.

George M Ibrahim,David W Cadotte,Mark Bernstein,Eduard J Beck

doi:10.1371/journal.pone.0120368

George M Ibrahim, David W Cadotte + Show 2 more

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https://doi.org/10.1371/journal.pone.0120368

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Journal: PloS one	Publication Date: Mar 30, 2015
Citations: 21	License type: CC BY 4.0

Affiliation: University of Toronto

Abstract

BackgroundAn estimated two billion people worldwide lack adequate access to surgical care. To address this humanitarian emergency, an increasing number of international surgical partnerships are emerging between developed and low- and middle-income countries (LMICs). At present, there are no clear indicators that may be used to assess the effectiveness of such initiatives.Study DesignWe conducted an international qualitative study of 31 surgeons from developed and LMICs involved in international partnerships across a variety of subspecialties. Thematic analysis and grounded theory were applied in order to develop a practical framework that may be applied to monitor and evaluate global surgical initiatives.ResultsSeveral themes emerged from the study: (i) there is a large unmet need to establish and maintain prospective databases in LMICs to inform the monitoring and evaluation of international surgical partnerships; (ii) assessment of initiatives must occur longitudinally over the span of several years; (ii) the domains of assessment are contextual and encompass cultural, institutional and regional factors; and (iv) evaluation strategies should explore broader impact within the community and country. Based on thematic analysis within the domains of inputs, outputs and outcomes, a framework for the monitoring and evaluation of international surgical initiatives, the Framework for the Assessment of InteRNational Surgical Success (FAIRNeSS) is proposed.ConclusionsIn response to the increasing number of surgical partnerships between developed and LMICs, we propose a framework to monitor and evaluate international surgical initiatives.

Highlights

An estimated two billion people worldwide lack adequate access to surgical care [1]
Several themes emerged from the study: (i) there is a large unmet need to establish and maintain prospective databases in low- and middle- income countries (LMICs) to inform the monitoring and evaluation of international surgical partnerships; (ii) assessment of initiatives must occur longitudinally over the span of several years; (ii) the domains of assessment are contextual and encompass cultural, institutional and regional factors; and (iv) evaluation strategies should explore broader impact within the community and country
In response to the increasing number of surgical partnerships between developed and LMICs, we propose a framework to monitor and evaluate international surgical initiatives

Summary

Introduction

An estimated two billion people worldwide lack adequate access to surgical care [1]. This humanitarian crisis is largely concentrated in low- and middle- income countries (LMICs), where inequities in access to surgery contribute to preventable death and disability [2]. Surgical care is increasingly understood to represent a cost-effective component of primary care in LMICs [5,6,7] and could play a critical role in improving multiple domains of healthcare [8]. Despite such recognition, surgical access remains poor and within many LMICs, the majority of surgical services are largely concentrated in urban centres, leaving rural communities with virtually no access to such care. There are no clear indicators that may be used to assess the effectiveness of such initiatives

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