Resource Mobilization for Global Surgery: Lessons Learned From US Government Appropriations Advocacy

Abstract

The US Agency for International Development (USAID) receives directives and funding through the appropriation process, though until recently, global surgery was not included in its mission. Nevertheless, an estimated five billion people lack access to safe, timely, and affordable surgical care, in large part due to lack of economic resources. Using coalition-based advocacy, the G4 Alliance successfully developed and submitted language that was incorporated into the 2020 Appropriations report language, directing USAID to financially support global surgery. This has significant implications for global surgical investment, yet few advocates are aware of the 2020 Appropriations language, let alone how they can utilize it now to advance global surgery in their respective countries. Here, we describe how advocates navigate the US appropriations process and the ways USAID funds are obtained for the purposes of global health. We also highlight the importance of coalition-based advocacy and provide guidance in how to increase success.

Advocacy for surgeons: Ensuring excellence in patient care

“…Mobilizing appropriate resources for the unmet needs within the healthcare system, particularly in relation to surgery is obvious and mandatory. 3–8 Patients’ needs but also their demands must be listened to, and the media brought on side from being blindly critical. Addressing disparities in access to surgical care is as urgent a need as 25 years ago.…”

Voices beyond the Operating Room: centring global surgery advocacy at the grassroots

“…Furthermore, in 2015, the World Health Assembly (WHA) passed Resolution 68.15, and WHA decision 70(22) in 2017, recognising surgical and anaesthesia care as essential for universal health coverage and requiring the director-general to report on the progress of its implementation, respectively 6 7. The efforts of various coalitions have led to the recent inclusion of global surgery in the US 2020 Appropriations bills directing the United States Agency for International Development (USAID) to support global surgery financially 8 9…”

Levelling up: prioritisation of global health

“…USAID is the US equivalent of DFID and is now headed by Dr Atul Gawande—who is probably well known to most of the medical/surgical community in the USA, UK & other high income countries for his four superb books around medical, surgical and healthcare practice [ 7 ]. A working group of the G4 alliance headed by Michael and Lismore Nebecker have been particularly successful in raising the awareness of SOTA care with the Senate Appropriations Committee and USAID [ 8 ]. We should learn from them and use that expertise to attempt to influence other G-7, and indeed G-20, countries.…”