Innovative financing to fund surgical systems and expand surgical care in low-income and middle-income countries

Abstract

Strong surgical systems are necessary to prevent premature death and avoidable disability from surgical conditions. The epidemiological transition, which has led to a rising burden of non-communicable diseases and injuries worldwide, will increase the demand for surgical assessment and care as a definitive healthcare intervention. Yet, 5 billion people lack access to timely, affordable and safe surgical and anaesthesia care, with the unmet demand affecting predominantly low-income and middle-income countries (LMICs). Rapid surgical care scale-up is required in LMICs to strengthen health system capabilities, but adequate financing for this expansion is lacking. This article explores the critical role of innovative financing in scaling up surgical care in LMICs. We locate surgical system financing by using a modified fiscal space analysis. Through an analysis of published studies and case studies on recent trends in the financing of global health systems, we provide a conceptual framework that could assist policy-makers in health systems to develop innovative financing strategies to mobilise additional investments for scale-up of surgical care in LMICs. This is the first time such an analysis has been applied to the funding of surgical care. Innovative financing in global surgery is an untapped potential funding source for expanding fiscal space for health systems and financing scale-up of surgical care in LMICs.

The Lancet Commission on diagnostics: transforming access to diagnostics

“…323 Fiscal space depends on various sources of finances: economic growth that creates favourable macroeconomic conditions for increased government revenues and budget; strengthening tax administration; reprioritisation of health within the government budget; borrowing from domestic and international sources or development assistance to invest in health; more effective and efficient allocation of available health resources; and innovative domestic and international financing. 324,325 Economic growth is generally seen as an important source for finance for health, particularly as the share of health spending in national income tends to increase with income. However, given the pandemic and the negative effects on growth and poverty, this is unlikely to be a major source of finance for diagnostics in the very near future.…”

Financing of surgery and anaesthesia in sub-Saharan Africa: a scoping review

“…Reddy et al 31 advocated moving beyond the traditional funding sources. They suggested innovative financing instruments that have been applied in other global health initiatives, such as voluntary solidarity levy (as in Unitaid), voluntary contributions (PRODUCT(RED)), performance-based instruments (GAVI), and securities and bonds (International Finance Facility for Immunisation (IFFI) and The Children’s Investment Fund Foundation (CIFF)).…”

COVID-19 pandemic: Revisiting the case for a dedicated financing mechanism for surgical care in resource-poor countries

“…Although earlier analyses indicated that only modest fiscal space expansions and IDA were needed for countries to scale up surgery [ 14 ], the additional COVID-19-related constraints on fiscal spaces for health mean that scale-up would now require substantial external resources. As the world emerges from the COVID-19 pandemic, though perhaps years later in SSA, donors should revisit earlier calls for a dedicated global financing platform for surgery, as suggested by Reddy et al, learning lessons from the likes of Global Fund to Fight AIDS, Tuberculosis and Malaria, GAVI, the Vaccine Alliance, and the Children’s Investment Fund Foundation [ 15 ]. A Global Surgery Fund as championed by the Global Surgery Foundation for instance [ 16 ] could finance initiatives for addressing access and quality of care, and the scale-up of tested approaches, drawing on recent evidence - see: https://www.surgafrica.eu/outputs2.html .…”