Gutnik Lily, Yamey Gavin, Riviello Robert, Meara John G, Dare Anna J, Shrime Mark G
Department of Surgery, University of Utah, Salt Lake City, UT USA ; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA USA ; Tidziwe Center, UNC Project Malawi, Privae Bag A-104, Lilongwe, Malawi.
Duke Global Health Institute, Duke University, Durham, NC USA.
Springerplus. 2016 Sep 13;5(1):1558. doi: 10.1186/s40064-016-3046-z. eCollection 2016.
The non-profit and volunteer sector has made notable contributions to delivering surgical services in low-and middle-income countries (LMICs). As an estimated 55 % of surgical care delivered in some LMICs is via charitable organizations; the financial contributions of this sector provides valuable insight into understanding financing priorities in global surgery.
Databases of registered charitable organizations in five high-income nations (United States, United Kingdom, Canada, Australia, and New Zealand) were searched to identify organizations committed exclusively to surgery in LMICs and their financial data. For each organization, we categorized the surgical specialty and calculated revenues and expenditures. All foreign currency was converted to U.S. dollars based on historical yearly average conversion rates. All dollars were adjusted for inflation by converting to 2014 U.S. dollars.
One hundred sixty organizations representing 15 specialties were identified. Adjusting for inflation, in 2014 U.S. dollars (US$), total aggregated revenue over the years 2008-2013 was $3·4 billion and total aggregated expenses were $3·1 billion. Twenty-eight ophthalmology organizations accounted for 45 % of revenue and 49 % of expenses. Fifteen cleft lip/palate organizations totaled 26 % of both revenue and expenses. The remaining 117 organizations, representing a variety of specialties, accounted for 29 % of revenue and 25 % of expenses. In comparison, from 2008 to 2013, charitable organizations provided nearly $27 billion for global health, meaning an estimated 11.5 % went towards surgery.
Charitable organizations that exclusively provide surgery in LMICs primarily focus on elective surgeries, which cover many subspecialties, and often fill deep gaps in care. The largest funding flows are directed at ophthalmology, followed by cleft lip and palate surgery. Despite the number of contributing organizations, there is a clear need for improvement and increased transparency in tracking of funds to global surgery via charitable organizations.
非营利和志愿部门在低收入和中等收入国家（LMICs）提供外科服务方面做出了显著贡献。据估计，在一些低收入和中等收入国家，55%的外科护理是通过慈善组织提供的；该部门的财政贡献为理解全球外科手术的融资优先事项提供了宝贵的见解。
搜索五个高收入国家（美国、英国、加拿大、澳大利亚和新西兰）注册慈善组织的数据库，以识别专门致力于低收入和中等收入国家外科手术的组织及其财务数据。对于每个组织，我们对外科专科进行分类，并计算收入和支出。所有外币均根据历史年度平均汇率换算为美元。所有美元均通过换算为2014年美元进行通胀调整。
确定了代表15个专科的160个组织。经通胀调整后，以2014年美元计算，2008 - 2013年期间的总综合收入为34亿美元，总综合支出为31亿美元。28个眼科组织占收入的45%和支出的49%。15个唇腭裂组织的收入和支出均占总数的26%。其余117个代表各种专科的组织占收入的29%和支出的25%。相比之下，2008年至2013年，慈善组织为全球健康提供了近270亿美元，这意味着估计有11.5%用于外科手术。
专门在低收入和中等收入国家提供外科手术的慈善组织主要专注于择期手术，这些手术涵盖许多亚专科，并且常常填补护理方面的巨大空白。最大的资金流向是眼科，其次是唇腭裂手术。尽管有众多捐赠组织，但通过慈善组织追踪全球外科手术资金的工作显然需要改进并提高透明度。
