Surgical Care and Health Systems

World J Surg. 2015 Sep;39(9):2132-9. doi: 10.1007/s00268-014-2928-x.


Background: While surgical care impacts a wide variety of diseases and conditions with non-operative and operative services, both preventive and curative, there has been little discussion concerning how surgery might be integrated within the health system of a low and middle-income country (LMIC), nor how strengthening surgical services may improve health systems and population health.

Methods: We reviewed reports from several meetings of the working group on health systems strengthening of the Global Initiative for Emergency and Essential Surgical Care, and also performed a review of the literature including the search terms "surgery," "health system," "developing country," "health systems strengthening," "health information system," "financing," "governance," and "integration."

Results: The literature search revealed no reports which focused on the integration of surgical services within a health system or as a component of health system strengthening. A conceptual model of how surgical care might be integrated within a health system is proposed, based on the discussions of our working group, combined with sources from the medical literature, and utilizing the World Health Organization's conceptual model of a health system.

Conclusions: Strengthening the delivery of surgical services in LMICs will require inputs at multiple levels within a health system, and this effort will require the coalescence of committed individuals and organizations, supported by civil society.

Publication types

  • Review

MeSH terms

  • Delivery of Health Care, Integrated / economics
  • Delivery of Health Care, Integrated / organization & administration*
  • Developing Countries*
  • General Surgery / economics
  • General Surgery / organization & administration*
  • Health Information Systems
  • Humans
  • Models, Organizational