Addressing power asymmetries in global health: Imperatives in the wake of the COVID-19 pandemic.

Seye Abimbola and co-authors argue for a transformation in global health research and practice in the post-COVID-19 world.

Colonisation and its aftermath: reimagining global surgery.

Coloniality in global health manifests as systemic inequalities, not based on merit, that benefit one group at the expense of another. Global surgery seeks to advance equity by inserting surgery into the global health agenda; however, it inherits the biases in global health. As a diverse group of global surgery practitioners, we aimed to examine inequities in global surgery. Using a structured, iterative, group Delphi consensus-building process drawing on the literature and our lived experiences, we identified five categories of non-merit inequalities in global surgery. These include Western epistemology, geographies of inequity, unequal participation, resource extraction, and asymmetric power and control. We observed that global surgery is dominated by Western biomedicine, characterised by the lack of interprofessional and interspecialty collaboration, incorporation of Indigenous medical systems, and social, cultural, and environmental contexts. Global surgery is Western-centric and exclusive, with a unidirectional flow of personnel from the Global North to the Global South. There is unequal participation by location (Global South), gender (female), specialty (obstetrics and anaesthesia) and profession ('non-specialists', non-clinicians, patients and communities). Benefits, such as funding, authorship and education, mostly flow towards the Global North. Institutions in the Global North have disproportionate control over priority setting, knowledge production, funding and standards creation. This naturalises inequities and masks upstream resource extraction. Guided by these five categories, we concluded that shifting global surgery towards equity entails building inclusive, pluralist, polycentric models of surgical care by providers who represent the community, with resource controlled and governance driven by communities in each setting.

Identifying opportunities for global surgery in Cameroon: an analysis of existing health policies and events.

Introduction: the burden of diseases amenable to surgery, obstetrics, trauma, and anesthesia (SOTA) care is increasing globally but low- and middle-income countries are disproportionately affected. The Lancet Commission on Global Surgery proposed National Surgical, Obstetrics, and Anesthesia Plans as national policies to reduce the global SOTA burden. These plans are dependent on comprehensive stakeholder engagement and health policy analysis. Objective: in this study, we analyzed existing national health policies and events in Cameroon to identify opportunities for SOTA policies. Methods: we searched the Cameroonian Ministry of Health´s health policy database to identify past and current policies. Next, the policies were retrieved and screened for mentions of SOTA-related interventions using relevant keywords in French and English, and analyzed using the 'eight-fold path´ framework for public policy analysis. Results: we identified 136 policies and events and excluded 16 duplicates. The health policies and events included were implemented between 1967 and 2021. Fifty-nine policies and events (49.2%) mentioned SOTA care: governance (n=25), infrastructure (n=21), service delivery (n=11), workforce (n=11), information management (n=10), and funding (n=8). Most policies and events focused on maternal and neonatal health, followed by anesthesia, ophthalmologic surgery, and trauma. National, multinational civil society organizations and private stakeholders supported these policies and events, and the Cameroonian Ministry of Public Health was the largest funder. Conclusion: most Cameroonian SOTA-related policies and events focus on maternal and neonatal care, and health financing is the health system component with the least policies and events. Future SOTA policies should build on existing strengths while improving neglected areas, thus attaining shared global and national goals by 2030.

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

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.