Sustainable surgical financing through philanthropy: an analysis of contributions to low- and middle-income countries (LMICs).

backgroundSurgery is an indispensable component of a health system, yet financing its delivery faces significant financing challenges. This study seeks to address the research question: What is the financial contribution of philanthropy to the delivery of surgical care in low and middle-income countries (LMICs)? METHODOLOGY: This study combines a qualitative and a quantitative component to examine the magnitude of philanthropic contributions in surgical care. The qualitative analysis is composed of a narrative review of peer-reviewed and gray literature that was conducted and synthesised through thematic analysis to identify patterns of philanthropic engagement. To quantify philanthropic contributions, a cross-sectional analysis was employed by using the Organization for Economic Cooperation and Development Creditor Reporting System, to identify philanthropic funding for surgical projects between 2014 and 2022.

resultsFour thematic domains were identified from the narrative review: (1) an overview of philanthropy, highlighting its role in filling critical funding gaps in financing health systems; (2) the modes of engagement in philanthropic giving, including partnerships with multilateral organisations, corporate social responsibility, domestic philanthropy, crowdfunding and remittances; (3) recipient channels such as non-profit, non-government organisations, faith-based organisations, non-profit private hospitals and academic institutions who more often contribute to surgical service delivery, research and capacity building; (4) facilitators include flexibility and risk tolerance, contrasted by barriers such as weak policy environments and donor dependency. Quantitatively, 10 philanthropic organisations collectively funded a total of $124.8 million to surgical care from 2014 to 2022. East Asia and the Pacific received the largest share totalling $38.02 million (30.5%). Pediatric surgery received the most amount of funding at $49.07 million (39.3%), with 95.3% contributed by the UBS Optimus Foundation.

conclusionGlobal surgery remains chronically underfunded despite its substantial burden of disease. Amid shifting financial aid landscapes, renewed philanthropic investment in global surgery is urgent. Philanthropy often focuses resources where perceived need is greatest. Although modest in scale, it has the potential to seed and catalyse surgical systems, advancing the expansion of access to surgical care in LMICs.