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.