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.

Access to equitable, safe, affordable, timely, and quality surgical healthcare in Africa remains limited. Few African countries have surgical healthcare plans or policies. Where these exist, there are significant gaps in dissemination, funding, and implementation. A Pan-African Surgical Healthcare Forum (PASHeF) was initiated to address this. The inaugural forum was a two-day consensus conference of technocrats from African Ministries of Health hosted by the Honorable Minister for Health of Rwanda in Kigali. Through coordinated discussions, plenary sessions, working groups, and technocrat networking, they charted the path forward for national surgical healthcare policies and plans. Discussions were sparked by country experiences, and working groups focused on curated context-specific, face-validated questions. Documentation involved field notes, audio recordings, and artificial intelligence transcription. Data was coded using a constant comparative method to itemize delegates’ observations, declarations, and recommendations, with member checking. A consensus statement was generated using an inclusive decision-making model. Thirty-two Ministries of Health were represented by 42 delegates who drafted and unanimously adopted the PASHeF 2023 Consensus Statement. This was a 50-point consensus addressing country commitment, leadership, financing, stakeholder mobilization, monitoring and evaluation, partnerships, and other aspects of national surgical healthcare planning in Africa. This consensus is the African roadmap and emphasizes implementation, the need for flexibility in policy development, and current opportunities and barriers. It emphasizes that community involvement and sustainability should undergird this planning, in addition to a focus on the entire spectrum of surgical healthcare, including prevention and rehabilitation. Delegates endorsed PASHeF as an annual event with a secretariat and recommended the creation of a Pan-African Surgical Healthcare Policy monitoring system, and that issues of surgical healthcare should be escalated as an agenda item on African Union and sub-regional ministerial meetings. African nations have embraced surgical healthcare policy as an imperative on their journey towards Universal Health Coverage.