A Systematic Review of Global Surgery Partnerships and a Proposed Framework for Sustainability

Background: Building surgical capacity through global surgery partnerships (GSPs) between high and low-middle income countries (LMICs) is a rising global health focus. This systematic review characterizes strategies employed by GSPs to build capacity and promote sustainability. Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). PubMed, Embase, Medline, and African Journals Online databases were searched to identify all peer reviewed articles from 2000-2016 describing GSPs between the US/Canada and LMICs. Descriptive features were analyzed, with focus on attributes that promote sustainability. Findings: 3580 abstracts were gathered and independently reviewed by four authors. 128 papers (3·6%) met inclusion criteria describing GSPs in 68 countries on 5 continents. Excluded papers were nonsurgical, unilateral, or military initiatives. 21·9% demonstrated community engagement and 51·6% included multidisciplinary collaboration. Surgical training or education was provided in 81·3% of GSPs. Whereas 64·8% of GSPs had data collection, 53·1% reported project-related outcomes. 55·5% had bilateral authorship, and 28·9% demonstrated multisource funding. Only one GSP fulfilled all six author-proposed criteria of sustainability. Interpretation: Features of GSPs' capacity building and sustainability fell into six pillars: community engagement, multidisciplinary collaboration, education and training, outcomes reporting, bilateral authorship, and multisource funding. We propose that future global surgery partnerships should build on a foundation of bilateral ideas and expertise exchange, defined and measurable objectives, continuous evaluation of program outcomes, and a thoughtful and transparent approach to sustained capacity building. Funding: None.Declaration of Interest: None to declare.Ethical Approval: Not required as per UBC Research Ethics Board eligibility criteria.