ArticleBMJ global health2016
The How Project: understanding contextual challenges to global surgical care provision in low-resource settings.
Article in BMJ global health, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 54 papers.
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Who cites it
54 citing papers in PubMed.
- Structures, processes and outcomes between first referral and referral hospitals in low-income and middle-income countries: a secondary preplanned analysis of the FALCON and ChEETAh randomised trials.BMJ global health · 2024Trial
- Mitigating Financial Barriers to Trauma Care in Cameroon Through Locally Designed Quality Improvement.World journal of surgery · 2026Observational
- Development of a low-cost external fixation system: an off-label solution for resource-limited settings.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026Article
- Magnitude and outcome of urologic emergencies: prospective cohort study.BMC emergency medicine · 2026Article
- Tonsillotomy by monopolar diathermy as a new procedure in Greenland: a feasibility study.International journal of circumpolar health · 2025Article
- Research and Learning Priorities for a Surgical Obstetrics and Family Planning Project Implementing in Low- and Middle-Income Countries: Results of an Expert Consultation.Global health, science and practice · 2025Article
- Scaling surgical care capacity in Nigeria: a narrative review of current practices and innovations in rural surgical workforce development.BMC surgery · 2025Review
- Analysis of the matching of community vitality and service facility supply and demand in the pedestrian bridge areas of Beijing.Scientific reports · 2025Article
- Exported students, imported surgeons: a narrative review of transnational surgical training and its impact on the surgical workforce of Solomon Islands.BMC surgery · 2025Review
- Surgical practice in a low-resource setting in an African context: a narrative review.Annals of medicine and surgery (2012) · 2025Review
- Pediatric surgery in Burkina Faso: capacity, gaps, and challenges.Pediatric surgery international · 2025Article
- Article
- Building a safe operative laparoscopy service in a resource-constrained setting: a case series.AJOG global reports · 2025Article
- Contextual challenges and impacts on the surgical ecosystem in Chiapas, Mexico: A qualitative study.PloS one · 2025Article
- Assessment of preoperative and intraoperative patient safety measures in government hospitals in the Gaza Strip: The nurses' perspective.SAGE open medicine · 2025Article
- Establishing a Microsurgical Practice in a Limited Resource African Setting: The Kapsowar Hospital Experience.Plastic and reconstructive surgery. Global open · 2024Article
- Ethical considerations in surgical research conducted in African LMICs: a comprehensive narrative review.Annals of medicine and surgery (2012) · 2024Review
- Defining blood deserts and access to blood products for 660 million people: a geospatial analysis of eight states in Northern India.BMJ global health · 2024Article
- Surgical informed consent practices and influencing factors in sub-Saharan Africa: a scoping review of the literature.BMJ quality & safety · 2024Article
- Augmented Reality (AR) in Surgery in Low- and Middle-Income Countries (LMICs): A Scoping Review.Cureus · 2024Article
Corrections and comments
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introduction5 billion people around the world do not have access to safe, affordable, timely surgical care. This series of qualitative interviews was launched by The
methodsFrom January 2014 to February 2015, 20 LCoGS collaborators conducted semistructured interviews with 148 surgical providers in low-resource settings in 21 countries. Stratified purposive sampling was used to include both rural and urban providers, and reputational case selection identified individuals. Interviewers were trained with an implementation manual. Following immersion into de-identified texts from completed interviews, topical coding and further analysis of coded texts was completed by an independent analyst with periodic validation from a second analyst.
resultsProviders described substantial financial, geographic and cultural barriers to patient access. Rural surgical teams reported a lack of a trained workforce and insufficient infrastructure, equipment, supplies and banked blood. Urban providers face overcrowding, exacerbated by minimal clinical and administrative support, and limited interhospital care coordination. Many providers across contexts identified national health policies that do not reflect the realities of resource-poor settings. Some findings were region-specific, such as weak patient-provider relationships and unreliable supply chains. In all settings, surgical teams have created workarounds to deliver care despite the challenges. DISCUSSION: While some differences exist between countries, the barriers to safe surgery and anaesthesia are overall consistent and resource-dependent. Efforts to advance and expand global surgery must address these commonalities, while local policymakers can tailor responses to key contextual differences.
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Registered trials
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