Dr. Barnabas Alayande

Introduction: Global surgery conferences are critical for sharing best practices, networking, developing policies and strengthening surgical systems, yet they often under-represent low- and middle-income countries (LMICs), perpetuating academic inequities. This study describes systemic barriers to frontline provider participation, and suggests actionable recommendations to facilitate the inclusion of LMIC voices at these conferences. Methods: The development of the consensus statement involved the Association for Academic Global Surgery’s Advocacy Committee in collaboration with several experts and volunteers from LMICs. A literature review and deductive thematic analysis were conducted to identify the key barriers to LMIC representation at global surgery conferences. Recommendations were proposed in a three-tiered format. A modified Delphi process was employed to gather consensus on the recommendations through a series of virtual meetings. Results: Our literature review identifies three fundamental barriers – financial, geopolitical, and limited access – ranging from unaffordable costs of attendance, to visa procurement and racism, to gender and language related disparities. Consequently, fewer abstracts, speakers, attendees, and publications from the global south are represented, perpetuating an imbalance in global discourse and knowledge sharing. During the consensus exercise, 30 recommendations were proposed. Of these, 26 achieved 100% agreement, and four met and exceeded the consensus threshold (80%) by the end of the second Delphi round. Conclusion: Recognizing that these changes take time, continued effort, and resource investment, we advocate for a tiered approach to our recommendations, enabling conference organizers to progressively achieve more inclusive and equitable practices. Key consensus recommendations include introducing fee waivers and travel grants to counter financial barriers for LMIC attendees, promoting hybrid conferences, advocating in political forums, and relocating events to visa-friendly countries to address geopolitical challenges. Additionally, live translation services, mentorship opportunities, and targeted advertising in LMIC forums can enhance access. Thoughtful advocacy across all levels of stakeholder engagement is imperative to democratizing global surgery dialogues and ensuring that international forums feature diverse and equitable representation.

Background: Implementation science (IS) stands as a bridge between clinical innovation and its routine practice. While crucial, its uptake in low-resource settings presents significant challenges. Despite significant contributions in innovative implementation strategies and policy change, concerns arise when adapting existing IS frameworks to suit low-resource settings. We aim to 1) Define the potential challenges in the uptake of implementation science in low-resource settings of sub-Saharan Africa, and 2) define the core competencies of an implementation scientist in low-resource settings. Methods: We employed qualitative, participatory design methods to collect, analyze, and interpret results. We invited 29 investigators experienced in research, teaching, and conducting IS in low-resource settings to provide their perspectives on IS in low-resource settings. Our discussion was framed in a workshop style, providing space for open dialogue and innovative thinking. Rapid thematic analysis was conducted using Microsoft Excel software. Emerging themes were identified and categorized, and then a coding tree was created and agreed upon by the facilitators and coders. Results were communicated to participants with an invitation to provide additional feedback, which was incorporated in the final results. Results: The four sub-themes describing challenges in the uptake of IS included (1) Limited IS capacity in low-resource settings, (2) Challenges in the applicability of IS in low-resource settings, (3) Barriers to changing the traditional approach to IS and how we view implementation science, and (4) Barriers to IS in general. Competencies required for an implementation scientist in low-resource settings included (1) cultural humility, (2) operationaling IS, and (3) partnering to increase advocacy for policy change. Conclusion: Capacity-building and equity are fundamental cornerstones for IS uptake in low-resource settings. It is vital to develop inclusive and culturally sensitive IS strategies that are tailored to the unique needs and challenges present in low-resource settings.