Implementation science: A missing link in global surgery

Keywords: implementation research, global surgery, global anaesthesia


Poor access to surgical and anaesthesia care is a major cause of global mortality and morbidity, affecting people in low- and middle-income countries (LMICs) most severely. Over 90% of the populations of sub-Saharan Africa and South Asia lack access to surgical and anaesthesia care, compared with less than 7% in high-income countries (HICs). In this perspective, we argue that this disparity exists not because we lack knowledge about the evidence-based surgical interventions and concepts, such as caesarean delivery, hernia repair, trauma care, and cleft lip and palate repair. LMICs are challenged with implementing and scaling these evidence-based practices, which are routinely implemented in HICs, in resource-limited settings. We propose an increase in the use of high-quality implementation science in global surgery to understand contextual factors that affect the scale-up of surgical systems in LMICs. Implementation science is the scientific study of methods to stimulate the systematic uptake of research findings on intervention efficacy into routine practice to improve the effectiveness and quality of healthcare. Evidence from implementation research can be used to design better dissemination and implementation strategies for the rapid scaling up of evidence-based surgical and anaesthesia interventions.