RCSI Institute of Global Surgery

Rooted in equity, and in collaboration with our partners, we create patient-centred, outcomes-based, global surgery research and education

RCSI.COM/GLOBALSURGERY INSTITUTE OF GLOBAL SURGERY

INSTITUTE OF GLOBAL SURGERY

RCSI Institute of Global Surgery

EQUITY - PATIENT-CENTREDNESS - COLLABORATION - EVIDENCE

Our vision Rooted in equity, and in collaboration with our partners, we create patient-centred, outcomes-based global surgery research and education

Pictured on the cover: Globally, five billion people lack access to safe, affordable and timely surgical care. The crisis is most acute in sub-Saharan Africa where ninety-three percent of the population is unable to access safe, affordable and timely surgical care.

PHOTO: SURG-AFRICA/ANTONIO JAÉN OSUNA.

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RCSI Institute of Global Surgery

EQUITY - PATIENT-CENTREDNESS - COLLABORATION - EVIDENCE

Our goals

› To keep the patient at the centre, always › To develop programmes that reach the underserved and the marginalised; to leave no one behind › To base every initiative in evidence, and where it does not exist, to create it › To generate and disseminate high-quality research › To create collaborations that are mutually beneficial › To deliver rigorous, transformative education in global surgery

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RCSI Institute of Global Surgery

EQUITY - PATIENT-CENTREDNESS - COLLABORATION - EVIDENCE

RCSI University of Medicine and Health Sciences As a University of Medicine and Health Sciences, the Royal College of Surgeons in Ireland (RCSI) is a degree-awarding institution specialising in medical and health sciences education, surgical training and research.

In 2021, RCSI was ranked joint second in the world by the Times Higher Education University Impact ranking for contribution to SDG 3, Good Health and Wellbeing.

The Institute of Global Surgery (IGS) is a new Institute at RCSI. It was established to address the global surgery crisis, recognising that five billion people worldwide do not have access to safe, affordable, and timely surgical and anaesthesia care, and that fixing this problem requires more than short-term solutions.

Founded in 1784, RCSI is a global institution with undergraduate medical programmes in Dublin, Bahrain and Malaysia; Schools of Medicine, Pharmacy and Biomolecular Sciences, Physiotherapy, Postgraduate Studies and Nursing and Midwifery; and Graduate Schools of Health Care Management in Ireland, Bahrain and the United Arab Emirates.

The IGS brings together and builds on RCSI’s track record of thirteen years’ experience in research, education, and training collaborations with partners in sub-Saharan Africa.

RCSI has a broad international reach and the ability to unlock significant advancement for patient safety and clinical outcomes worldwide.

Find out more: rcsi.com

RCSI is a signatory to the Sustainable Development Goals (SDG) Accord, and is committed to achieving the SDGs through its education, research and university operations.

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RCSI Institute of Global Surgery

EQUITY - PATIENT-CENTREDNESS - COLLABORATION - EVIDENCE

The World Health Organisation (WHO) has stated that surgery is an integral, indivisible component of a properly functioning health system, and that all people should have access to safe, high-quality surgical and anaesthesia care with financial protection when needed.

PHOTO: SURG-AFRICA/ANTONIO JAÉN OSUNA

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RCSI Institute of Global Surgery

EQUITY - PATIENT-CENTREDNESS - COLLABORATION - EVIDENCE

What is global surgery?

By addressing a lack of access wherever it occurs, we do not limit our work to any particular region. We aim instead to work where the need and potential impact is greatest.

At the IGS we define global surgery as follows: a field that aims to understand and address the impediments to the equitable provision of safe, affordable, and timely surgical, anaesthetic, and obstetric care to people and to patients worldwide, through research, education, and international collaboration.

Global surgery is not simply “surgery over there”; populations within high-income countries also face barriers and impediments to surgical care. The focus of IGS activities to date in sub-Saharan Africa is a result of the fact that the highest burden of disease and lowest access to care is in this region.

By aiming to understand and reduce the impediments to care, we take a public health approach to surgical access. We are interested in addressing the why behind these barriers — identifying them through research and lowering them through our programmes.

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RCSI Institute of Global Surgery

EQUITY - PATIENT-CENTREDNESS - COLLABORATION - EVIDENCE

Our current programmes The IGS currently reaches patients and surgical teams in over forty countries through our education, research and training programmes.

Akazi; Africa Paediatric Surgery E-learning; KidSURG; RCSI/COSECSA Collaboration Programme Africa Paediatric Surgery E-learning; Global Surgical Training Challenge; RCSI/COSECSA Collaboration Programme Africa Paediatric Surgery E-learning; RCSI/ COSECSA Collaboration Programme Africa Paediatric Surgery E-learning; Global Surgical Training Challenge Global Surgical Training Challenge

Global Surgical Training Challenge

Africa Paediatric Surgery E-learning Africa Paediatric Surgery E-learning; RCSI/COSECSA Collaboration Programme; Operation Childlife

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ESWATINI

RCSI Institute of Global Surgery

EQUITY - PATIENT-CENTREDNESS - COLLABORATION - EVIDENCE

Find out more about all our current programmes rcsi.com/surgery/global-surgery/our-work

Global Surgical Training Challenge Atlantic Surgical Leadership Exchange; Operation Childlife

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RCSI Institute of Global Surgery

EQUITY - PATIENT-CENTREDNESS - COLLABORATION - EVIDENCE

How we realise our vision Patient-Centredness

We recognise that traditional beliefs play a significant, but understudied, role within the healthcare system, often at great cost to patients. Although cost is repeatedly cited as the highest barrier to care by patients, demand-side barriers as a whole limit their access.

These demand-side barriers place a hard ceiling on the effectiveness of our training programmes.

Patient-centredness is easy to claim, harder to accomplish. At the IGS, we take a holistic view of patient-centredness.

We recognise that it is more than surgical volume, mortality, and morbidity. Patients care not only about receiving their surgery but about being able to do so in a way that does not impoverish them, that allows them to return to their pre-health-shock life, and that respects their autonomy.

Finally, we recognise that both providers and systems benefit from patient-centred care as well. If patients are happy, providers tend to work better and more effectively, and if traditional approaches to healthcare are be incorporated within the overall referral system, holistic patient outcomes are likely to improve.

They care about consent, about infrastructure that meets them where they are, about coordination and referral systems that help them navigate the system, and about access to care close to where they live.

The research and educational pillars of the IGS have come together through a shared focus on patient-centredness, a focus which sets us apart from much of the global surgery space. We grow this emphasis through deepening our focus on patient-centered structures and outcomes in both educational and research initiatives.

We also recognise that the barriers that patients face are multifactorial. We recognise that the primary barriers reported by patients are demand-side: they are financial, cultural, social, and structural barriers.

We believe that safe, affordable, and timely access to surgery can improve the whole patient - health, financial security, and (re-) integration into a community - so we incorporate these outcomes into our assessments.

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RCSI Institute of Global Surgery

EQUITY - PATIENT-CENTREDNESS - COLLABORATION - EVIDENCE

For many patients, surgery could alleviate disability, poverty and premature death associated with non-communicable diseases.

PHOTO: SURG-AFRICA/ANTONIO JAÉN OSUNA.

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RCSI Institute of Global Surgery

EQUITY - PATIENT-CENTREDNESS - COLLABORATION - EVIDENCE

Outcomes-Based

Rooted in Equity

Providers and researchers are incentivised to do more, not better.

Surgeons are more often measured by the number of procedures they perform, rather than the quality of those procedures. Similarly, Inequities exist throughout the health system of any country. Adverse educational and research interventions are judged by the number of outcomes, access barriers, and sometimes overt discrimination are people trained or procedures created. present for both patients and students, including those who come While we acknowledge that too few surgical procedures are from marginalised communities. performed in most countries, we also recognise that incentivising At the IGS, we design programmes with our partners to combat volume can have serious adverse consequences. these inequities at both individual and population levels.

As a result, we commit to incorporating outcomes other than We base our work in equity, and we understand that marginalisation volume into all of our educational and research projects. We and exclusion are intersectional. We seek to understand our own incorporate evidence into the design of our research and biases so that we can combat them when we find them. We believe educational programmes, and, where that evidence does not this is essential for the delivery of stronger health systems, whether exist, we create it through high-quality, rigorous research. in Ireland or with our partners overseas.

Health inequity manifests in unjust differences in health determinants, opportunities, and outcomes.

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RCSI Institute of Global Surgery

EQUITY - PATIENT-CENTREDNESS - COLLABORATION - EVIDENCE

Our team

Collaborative

The staff of the IGS is drawn from across RCSI. We are a multidisciplinary and diverse team currently encompassing surgeons; researchers; programme and project managers; education specialists; communications specialists and statisticians.

Current structures in global health often default to a North-to-South flow of influence, funding, and information. The primary drivers of change on the ground, however, are surgeons and institutions in low- and middle-income countries.

Find out more rcsi.com/surgery/global-surgery/people-and-partners

We commit to breaking this trend through developing mutually beneficial partnerships, in concordance with our vision of being patient-centred, equity-focused, and outcomes driven.

We commit to a stance of mutual transformation, recognising that, just because a solution has worked in the global North does not mean it is the right solution for every setting and situation.

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RCSI Institute of Global Surgery

EQUITY - PATIENT-CENTREDNESS - COLLABORATION - EVIDENCE

Our funders Our work is enabled by competitively-awarded grants and donations from private funders including national and regional authorities; philanthropic foundations; commercial companies; and charities.

We welcome opportunities to discuss new initiatives aligned to our vision and goals with potential funders.

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RCSI Institute of Global Surgery

EQUITY - PATIENT-CENTREDNESS - COLLABORATION - EVIDENCE

Our implementation partners We design and deliver our current programmes in collaboration with partners from a range of sectors which currently include academia; non-governmental organisations and professional bodies. › Appropedia

› College of Anaesthesiologists of East, Central and Southern Africa (CANECSA) › College of Anaesthesiologists of Ireland (CAI)

› College of Surgeons of East, Central and Southern Africa (COSECSA) › East, Central and Southern African Health Community (ECSA-HC) › Hanoi Medical University › Malawi Paediatric Trust

› Management Sciences for Health › MIT Solve

› Nesta Challenges

› Operation Childlife › UNITAR

› West African College of Surgeons (WACS) We welcome opportunities to discuss new initiatives aligned to our vision and goals with potential implementation partners.

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RCSI Institute of Global Surgery

EQUITY - PATIENT-CENTREDNESS - COLLABORATION - EVIDENCE

Scaling up surgical care, particularly in low- and middleincome countries, is imperative to accelerate attainment of UN Sustainable Development Goal 3: Health and Wellbeing.

PHOTO: SURG-AFRICA/ANTONIO JAÉN OSUNA.

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RCSI Institute of Global Surgery

EQUITY - PATIENT-CENTREDNESS - COLLABORATION - EVIDENCE

O’Brien Chair of Global Surgery Prof Mark G Shrime MD, MPH, PhD, FACS was appointed the inaugural O’Brien Chair of Global Surgery at RCSI in 2020.

Professor Shrime’s research has been supported by Enterprise Ireland, the Damon Runyon Cancer Foundation and by an anonymous donation to the Center for Global Surgery Evaluation; he has previously received research support from the GE Foundation’s Safe Surgery 2020 project and the Steven C. and Carmella Kletjian Foundation.

Professor Shrime joined RCSI from Harvard Medical School and the Massachusetts Eye and Ear Infirmary, where he was Director of the Center for Global Surgery Evaluation.

He is a co-author of Lancet Commission Report, ‘Global Surgery 2030’, which highlighted the deficit in the equity of surgical and anaesthesia care globally.

In 2018, he was awarded the Arnold P. Gold Humanism in Medicine Award by the American Academy of Otolaryngology—Head and Neck Surgery.

His academic pursuits focus on surgical delivery in low- and middleincome countries. He has a specific interest in the intersection of health, impoverishment, and inequity.

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RCSI Institute of Global Surgery

EQUITY - PATIENT-CENTREDNESS - COLLABORATION - EVIDENCE

How to reach us Prof Mark Shrime O’Brien Chair of Global Surgery markshrime@rcsi.com

Eric O’Flynn Programme Director – Education, Training and Advocacy ericoflynn@rcsi.com

Dr Jakub Gajewski Programme Director – Research jakubgajewski@rcsi.com

Deirdre Mangaoang Programme Director – Operations deirdremangaoang@rcsi.com

INSTITUTE OF GLOBAL SURGERY RCSI Institute of Global Surgery, Beaux Lane House, Mercer Street Lower, Dublin 2, D02 DH60, Ireland Email: globalsurgery@rcsi.com Web: rcsi.com/globalsurgery Twitter: @RCSI_GlobalSurg

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