The NIHR Global Health Research Unit on Global Surgery

The Lancet Commission and World Health Organisation  have identified that 5 billion people lack access to safe, affordable surgical and anaesthesia care. In Low and Middle Income countries (LMIC) 9 out 10 people lack access to even the most basic surgical services. An estimated 4.2 million people will die each year within 30 days of surgery – more than from all causes related to HIV, malaria, and tuberculosis combined.

A critical need exists to reduce inequalities in surgical care throughout the world. High quality collaborative research and training are essential to improve  mortality and outcomes following surgery for patients in LMIC.

The NIHR Global Health Research Unit on Global Surgery (GSU) is working with internationals partners to establish research hubs in sub-Saharan Africa, the Indian sub-continent, South East Asia and Central America.

The NIHR GSU is led by the University of Birmingham in partnership with the Universities of Edinburgh and Warwick, and international partners from the GlobalSurg Collaborative in a range of LMICs.

NIHR Global Surgery research hubs are funded by the NIHR and supported by their academic host institutions.

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NIHR GSU Activities

The NIHR GSU was established in July 2017 following substantial investment from the National Institute of Health Research Overseas Development Aid funds in response to the Lancet Commission report, Global Surgery 2030 and The World Health Organisation’s Emergency and Essential Surgical Care Programme. 

Surgery can be considered an umbrella discipline; improving surgical services can treat a wide variety of conditions from trauma injuries to obstructed labour, and cancer.  Our own analysis on the global burden of post-operative death has estimated that at least 4·2 million people worldwide die within 30 days of surgery each year, and half of these deaths occur in LMICs. This number of postoperative deaths accounts for 7·7% of all deaths globally, making it the third greatest contributor to deaths, after ischaemic heart disease and stroke. More people die within 30 days of surgery annually than from all causes related to HIV, malaria, and tuberculosis combined (2·97 million deaths).

The  main objective of the NIHR is to build sustainable research and training capacity in our partner LMIC, delivering the United Nations Sustainable Development goals of Good Health and Well BeingIndustry, Innovation and InfrastructureReducing Inequalities; and Partnership for Goals. 

The NIHR GSU developed from The GlobalSurg Collaborative, an international network of surgical researchers. The National Institute of Health Research Overseas Development Aid funds the work of the GSU hubs in LMIC.

GlobalSurg studies are unfunded and open to any hospital, anywhere in the world.

The Global Surgery Unit is based on a ‘Hub & Spokes Model’.

Research ‘hubs’ are established in larger, usually urban hospitals. Each hub acts as an independent research centre, running clinical trials and cohort studies, and supporting research training and education within its local context. The hubs receive resources to support the delivery of local training and research at smaller, often rural, ‘spoke’ hospitals.

To date, hubs have been established in: Ghana, Rwanda, South Africa, Mexico, India and Nigeria..

The hub and spokes model ensures all local patients have the opportunity to be included in research studies and to benefit from the resources provided by their Hub.

Most importantly, we are engaging local surgeons; we believe long term sustainability can only be achieved if clinicians within LMICs are empowered to design and deliver the clinical research needed to improve surgical outcomes for their own patients.

Our ambition is to train front line clinicians and health professionals to deliver clinical prioritisation and research that will challenge and improve surgical practice within their own countries and where the need is greatest.

Working in this way, the NIHR GSU will build and strengthen research capacity in partner countries ensuring long-term sustainability of high quality research, and ultimately improving surgical outcomes for patients around the world.

The ethos of the NIHR GSU is inclusive and collaborative; we are harnessing our broad collaborative networks to initiate and advance practice-changing research that will have a real impact in LMICs.

Every year one of the GSU hubs hosts a Research Prioritisation Workshop where surgical researchers, healthcare professionals and policy makers from across the world meet to discuss research themes and priorities. Areas of unmet clinical need that will benefit most from high quality research are identified through online engagement with our network and discussed at priority-setting workshops