Global Surgery Advocacy and the US Government

Surgical conditions constitute 28-32% of the global burden of disease, and yet surgery receives negligible funding through the US government. With looming global health budget cuts and an increasingly crowded landscape of global health and international development initiatives vying for funding, how can global surgery grow its support within the US government? During her presentation to the Program in Global Surgery and Social Change (PGSSC), Sara Anderson, Senior Advisor for Advocacy and Innovation for ReSurge International, shared the importance of advocacy and strategies for accomplishing this goal.

“Advocacy is putting your issues on other people’s agendas.”

This is a quote from US Ambassador Jimmy Kolker, who was the top global health diplomat until January 2017. It is also an advocacy strategy that can work for increasing political priority for global surgery, Anderson said.

Anderson’s global surgery advocacy derives from her position at ReSurge International, a 50-year-old surgical NGO that provides reconstructive surgical care and builds capacity in developing countries. They serve in fourteen countries, help train local residents and surgeons, and treat thousands of patients annually. Notably, their model enables 90% of all surgeries to be performed by local partner surgeons.

The Lancet Commission on Global Surgery (LCoGS) and subsequent surgical system research has had a major impact on ReSurge’s recent approach to its mission. Stemming from LCoGS recommendations, ReSurge now views its work with a larger public health lens. It works to align its interventions and training around the most pressing surgical problems as delineated in global surgery research and local priorities. The evidence and recommendations from LCoGS, coupled with the engagement of like-minded groups for advocacy, also helped ReSurge and other organizations strive toward new global standards and goals, and provided a foundation for new collaborations and the sharing of best practices.

The PGSSC team with Sara Anderson.

On a broader scale, research on global surgical systems has enabled civil society to advocate for surgery on a national and international level. “Effective advocacy is not sustainable without solid evidence,” said Anderson. Research and civil society engagement have been key factors enabling the global surgery movement to gain traction on an international level, most visibly with World Health Assembly resolution 68.15. Yet, while the US government supported WHA 68.15 and there have been some wins, surgery continues to receive negligible US government funding, especially in comparison to other global health issues like HIV/AIDS and malaria. This is particularly unfortunate as the United States is the largest government contributor to global health and a powerful global influence given its position in multilateral organizations like the United Nations and World Health Organization

Many avenues exist for putting global surgery on the US government agenda. To highlight these, Anderson described the unique roles of the various legislative branch committees and executive branch departments. Each has different leaders setting the agendas, but there exist common reasons for US investment in global health:

1. To improve lives and contribute to broader US global goals, including economics.

2. To promote national security by stopping disease outbreaks and other global health threats.

3. To strengthen health systems in order to reduce poverty.

4. To leverage the US dollar.

5. To promote research and development for new technology and tools.

Strong advocacy is needed because challenges abound in the current political climate. The US government has proposed significant cuts in global health funding ($10.8 billion in FY 2018 to $8.3 billion in FY 2019), has maintained long and complex funding processes, and has endorsed political strategies that could result in decreased support for multilateral organizations. However, global surgery has an expanding evidence base that allows advocates to support its inclusion in existing global health initiatives. Maternal and child health (MCH), health workforce, and health systems strengthening are existing global health initiatives that provide opportunities for global surgery.

“The current foreign assistance field is crowded and faces dwindling resources. To combat this situation, I recommend increasing engagement with existing global health communities, like maternal and child health,” said Anderson. “These selected target communities are based on US global health priorities that have the greatest overlap with global surgery and need a surgical component to achieve their goals.”

Anderson made specific recommendations on ways to integrate and engage with these existing agendas:

1. Join targeted global health advocacy coalitions to understand their agendas, increase awareness of global surgery, and meet policymakers with them.

2. Attend key MCH, health workforce, and global health community key meetings and conferences, like the Global Health Council’s Briefing Book Hill Day in DC.

3. Further develop the core global surgery message by expanding research on the cost-effectiveness of surgery and surgery’s crucial place in meeting global goals like Sustainable Development Goal 3 and even US government’s MCH goals.

4. Intentionally frame the global surgery message to:

• Focus on the economic impact.

• Abolish the notion that surgery is a luxury.

• Highlight surgery’s fundamental importance in primary health care.

• Emphasize that the international community cannot achieve global goals like SDG 3 without a surgical component.

Global surgery has gained a few victories in US government programs, including the USAID Fistula Care Project and the USAID Maternal and Child Survival Program. These are important programs and they signify that further progress is possible. Fortunately, Anderson has the vision and experience to increase the US government’s awareness of surgery as a critical component for reaching global health priorities. Here at the PGSSC, we look forward to working in partnership to accomplish this goal.