World Journal of Surgery

, Volume 43, Issue 3, pp 736–743 | Cite as

Strengthening Surgery Strengthens Health Systems: A New Paradigm and Potential Pathway for Horizontal Development in Low- and Middle-Income Countries

  • S. Ariane Christie
  • Benedict C. Nwomeh
  • Sanjay Krishnaswami
  • George P. Yang
  • Ai-Xuan L. Holterman
  • Anthony Charles
  • Sudha Jayaraman
  • Randeep S. Jawa
  • Jennifer Rickard
  • Mamta Swaroop
  • Sifri C. Ziad
  • Georges Alain Etoundi Mballa
  • Martin Ekeke Monono
  • Alain Chichom Mefire
  • Catherine JuillardEmail author
Surgery in Low and Middle Income Countries


Global health is transitioning toward a focus on building strong and sustainable health systems in developing countries; however, resources, funding, and agendas continue to concentrate on “vertical” (disease-based) improvements in care. Surgical care in low- and middle-income countries (LMICs) requires the development of health systems infrastructure and can be considered an indicator of overall system readiness. Improving surgical care provides a scalable gateway to strengthen health systems in multiple domains. In this position paper by the Society of University Surgeons’ Committee on Global Academic Surgery, we propose that health systems development appropriately falls within the purview of the academic surgeon. Partnerships between academic surgical institutions and societies from high-income and resource-constrained settings are needed to strengthen advocacy and funding efforts and support development of training and research in LMICs.


Compliance with ethical standards

Conflicts of interest

All authors declare that they have no conflict of interest.


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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • S. Ariane Christie
    • 1
  • Benedict C. Nwomeh
    • 2
  • Sanjay Krishnaswami
    • 3
  • George P. Yang
    • 4
  • Ai-Xuan L. Holterman
    • 5
  • Anthony Charles
    • 6
  • Sudha Jayaraman
    • 7
  • Randeep S. Jawa
    • 8
  • Jennifer Rickard
    • 9
  • Mamta Swaroop
    • 10
  • Sifri C. Ziad
    • 11
  • Georges Alain Etoundi Mballa
    • 12
  • Martin Ekeke Monono
    • 13
  • Alain Chichom Mefire
    • 14
  • Catherine Juillard
    • 1
    Email author
  1. 1.UCSF Center for Global Surgical Studies, Zuckerberg San Francisco General Hospital and Trauma CenterSan FranciscoUSA
  2. 2.Ohio State University Wexner Medical CenterColumbusUSA
  3. 3.Oregon Health and Science University Medical CenterPortlandUSA
  4. 4.Department of SurgeryUniversity of Alabama at BirminghamBirminghamUSA
  5. 5.Department of Pediatrics and SurgeryUniversity of Illinois College of MedicineChicagoUSA
  6. 6.University of North Carolina School of MedicineChapel HillUSA
  7. 7.VCU Program for Global Surgery, Department of SurgeryVCU School of MedicineRichmondUSA
  8. 8.Department of Surgery, Stony Brook University School of Medicine, Health Sciences Center T18-040Stony Brook MedicineStony BrookUSA
  9. 9.Department of Surgery and Critical CareUniversity of MinnesotaMinneapolisUSA
  10. 10.Northwestern University’s Feinberg School of MedicineChicagoUSA
  11. 11.Rutgers New Jersey Medical SchoolNewarkUSA
  12. 12.Ministry of Public Health, CameroonYaoundéCameroon
  13. 13.World Health Organization (WHO) Regional OfficeBrazzavilleRepublic of the Congo
  14. 14.Faculty of Health SciencesUniversity of BueaMolyko, BueaCameroon

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