ReviewBMC surgery2025
Financing surgery in LMICs: building sustainable and equitable systems for universal surgical access - a narrative review.
Review in BMC surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
0 citing papers in PubMed.
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Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionSurgical conditions account for nearly a third of the global disease burden yet financing for surgery in Low- and Middle-Income Countries (LMICs) remains fragmented, under-prioritized, and heavily dependent on out-of-pocket (OOP) payments.
methodsThis narrative synthesis focuses on how surgical services are financed in LMICs and what models are emerging to build sustainable, equitable systems. Applying the World Health Organization (WHO)'s health financing framework-revenue generation, pooling, and purchasing -we synthesize quantitative and qualitative evidence from recent literature, with reference to country case studies and economic models.
findingsMost LMIC surgical care is financed predominantly through OOP payments, with minimal earmarked government funds and limited donor contributions. Coverage by insurance is often inadequate and fails to provide true financial protection. Donor support for surgery remains low and uncoordinated. All these structural gaps contribute to inequities in access as well as high-frequency Catastrophic Health Expenditures (CHE). The promising strategic purchasing, performance-based financing (PBF), and National Surgical, Obstetric, and Anesthesia Plan (NSOAP) models have promise when employed with universal health coverage (UHC) goals. The models of Rwanda and Ghana serve to illustrate how pooled financing, political leadership, and national plans can drive access, financial protection, and service quality improvement. The narrative review highlights key enablers of sustainable financing: political commitment, risk pooling, earmarked taxes, public-private partnerships, and integration of surgery into broader UHC frameworks. Improved data systems for monitoring surgical costs, access, and outcomes are essential to inform investment decisions and track progress.
conclusionSurgery financing is not only a public health imperative but also an economically sound investment. We conclude with strategic recommendations for policymakers, global health actors, and donors to design financing models that prioritize equity, resilience, and long-term health system strengthening.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.