Implementation science: A missing link in global surgery
Poor access to surgical and anaesthesia care is a major cause of global mortality and morbidity, affecting people in low-income and middle-income countries (LMICs) mostly severely. Over 90% of the population of sub-Saharan Africa and South Asia lacks access to surgical and anaesthesia care compared to less than 7% in high-income countries (HICs). In this perspective, we argue that this disparity exists not because we lack knowledge of evidence-based interventions needed to treat surgical conditions, such as Caesarean delivery, hernia repair, trauma from road traffic injuries, and cleft lips and palates. The main challenge LMICs face is how to implement and scale these evidence-based practices, which are being routinely practiced 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.