This is the second part of our summary of the G4 alliance Permanent Council, Geneva meeting. Read more about what is happening now in global surgery, how to break the silos and a global surgery foundation update.
The Global Surgery Leap: what is happening in global surgery and how should global surgery reform itself and be part of global health discussions?
One important goal is that the global surgery community needs to ensure that global surgery is integrated into the WHO and UN health as it is restructured. This way we can support the formation of NSOAPs; Dr Kee Park says: “34-40 countries have an NSOAP and this is in-line with what the new structure calls for” but there needs to be a shift in funding. Dr Park advocates for regional surgical financing of NSOAPs using non-traditional ways to finance. Government funded financial aid (ODA) (typically from HIC to LMICs) is decreasing. Dr Nardeen Darwood discussed this further; “There has been a 23% reduction in ODAs which includes a 63% reduction from USA alone. Financially this equates to a reduction in $20 billion aid overall – $13 billion from USA.” Last year the USA launched, America First global health strategy which outlines that any aid from the USA must also be in the interest of the USA, often financially, for example manufacturing and exporting goods to Africa. This has led to MoUs from the USA being rejected (by Ghana) and suspended (by Kenya) due to concerns about data sharing, bio-sharing and mineral exploitation. Africa CDC have outlined that they want 60% of healthcare goods to be manufactured locally and so a shift is needed. Dr Darwood suggested co-investment models which have attainable benchmarks with no non-health conditionalities could be another way forward. This way the countries can keep their citizens data ownership and can determine what their health priorities are.
Dr Irene Dzirasa agreed, saying; “country partnerships are the way forward”. The Ghanaian NSOAP is using domestic funding, public-private partnerships (PPP) and ring-fenced funding for example, they are developing local manufacturers of devices which they can supply internally and to neighbouring countries. This has shifted the Ghanaian mindset from; “donor dependency to co-creation and co-financing”. In Pakistan, they had a different experience. In 2016, they agreed to an NSOAP and Provincial SOAPs which were launched in 2019. In March 2026, no one could find the plan. Professor Tariq Khan identifies this as down to the lack of leadership. For Prof Khan, his mission is to get TBI classified as a notifiable, chronic condition so that by collecting data on TBI, funding and resources will be correctly allocated and hardwired in a governance and accountability framework. Dr Rose Alenyo, first female plastic surgeon in Uganda, adds; “surgical leaders need to get streseds to make changes”.
In the open questions, the panellists outlined that out-of-pocket spending is the highest in lowest income countries. From the USA, financial aid is mostly sent to HIV, tuberculosis and malaria but nothing much is allocated for child and maternal health or system strengthening. Dr Darwood says the global surgical community can engage by reforming working groups and using non-state actors, like academic groups and NGOs. Dr Alenyo added that the global surgery community needs to identify which table to sit at.
Breaking the silos and working in teams
In Cambodia, nurse-trained Manila Prak has been at the forefront of patient safety and quality improvement for 20 years. One of her main strategies is using shared language amongst professionals. They developed the SBAR handover which enables safe handoffs and easy escalation of patient deterioration and ensures no communication is missing. In Columbia, Dr Maria Escobar has been working on reducing maternal mortality using technology to provide education and referral pathways. By cooperating with governments; local and national, Columbia has used telehealth and WhatsApp to connect teams across the country – they have engaged 466 hospitals. Published in the lancet, they have reduced maternal mortality ratio from 70% in 2021 to 20% in 2026. This type of integration works and lasts by studying the culture before acting by mapping stakeholders and frameworks, using expert power to align policies by using one well aligned decision to solve multiple problems which gives confidence at implementation level, training multidisciplinary teams, aiming for system integration not tool collection and building a blame-free culture.
GSF and SurgHub update
SurgHub works to be a one stop shop for training in resource limited settings. They currently have 46,000 users who have accessed 138 courses in more that 207 countries. SurgHub has received 2 international education awards. Recently, the highest proportion of users has been nurses and so they are expanding their content to reflect this. It is currently free for end users and content providers retain their intellectual copyright. Now, they are able to use innovative financing strategies and source monies from corporate donors. Their most downloaded course is the basics of surgery which was developed by COSECSA.
