NIHR Global Health Research Unit on Global Surgery

/NIHR Global Health Research Unit on Global Surgery
NIHR Global Health Research Unit on Global Surgery 2020-06-26T07:32:24+00:00

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.

Read the GSU Brochure

Click here to read the GSU brochure


Download the PDF version here

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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

Working in this way to identify research priorities is the first step in the cycle of information gathering, evidence generation, and implementation & policy change that is the working model of the NIHR GSU. This is the process through which we ultimately aim to change surgical practice throughout the world.

The first research prioritisation workshop was held in 2017 and hosted in Johannesburg by the South Africa hub

The 2018 Research Prioritisation workplace took place in Kigali, hosted by the Rwanda hub – you can read full reports of each day of meeting here: Day 1, Day 2, Day 3, final round up.

The 2019 Research Prioritisation workshop will be held in Accra and Tamale hosted by the Ghana hub.

The outcomes from our research prioritisation workshops have identified several main themes which form the basis of the NIHR GSU research studies, leading ultimately to international, multi-centre studies in there areas.

These are: Cancer, Surgical Site Infections, Access to Surgery, and Perioperative Care 

At the NIHR GSU we recognise that training and supporting the next generation of surgeon-scientists is the foundation of building research capacity and sustainable improvements in surgical care in LMIC.

Fully funded Fellowships are available for surgical trainees from Hub countries to undertake post-graduate degree qualifications via online, distance learning programmes at the University of Edinburgh – please see our .

The GSU also has also  a virtual learning environment ( which provides open access general research training modules and bespoke project-specific training for Unit research studies.

In addition to online training, The GSU also delivers face-to-face research skills training at our Annual Research Prioritisation workshop and facilitates training in Basic Surgical Skills provided by the Royal College of Surgeons, England. As part of our pump-priming surgical research awards, we are also enabling educational visits whereby researchers are able to visit colleagues at neighbouring hubs in order to share knowledge and experience.

The dedicated GSU Education & Training Committee includes representation from each hub and steers the training activities of the unit.

Improving outcomes for patients is central to the work of the Global Surgery Unit.

To ensure that our research is relevant to communities in LMICs, we aim to involve patients with lived experience and the public in the prioritisation, design and implementation of all our clinical trials and studies. This ensures that local healthcare needs are being met and potential barriers and challenges are overcome early on, guaranteeing the success of our studies and allowing us to have a greater impact on surgical healthcare in LMICs.

Our dedicated Community Engagement & Involvement manager is working to capture and report on all engagement and involvement activities across our research hubs. This will allow us to share our experiences with the wider global health network with the aim of supporting the development of an empowered public across the world.

Learn more about our CEI activities and read up on our LMIC-based case studies here.

Health economics considers the cost effectiveness of any treatment. We embed this at every stage of our research studies from initial design and planning through to execution and analysis.

This will guide development of health economic models that can be used in multiple settings where costs and resources may differ.

See our Health Economics page for further details.

The majority of the world’s population lack access to timely hospital care. In low & middle income countries, 98% of patients lack access to safe, affordable surgical care.

Those that do reach hospital often experience delays in their care, contributing to the observed increased death rates in LMICs.

Our Access to Surgical Care project is surveying patients, policy makers and healthcare providers to identify the barriers and potential solutions in order to improve access to surgical care for patients in LMICs.

In order to improve outcomes for patients, it’s crucial that innovations identified by research are implemented globally.

The NIHR GSU Policy & Implementation Committee has been established to work with national governments, professional associations and international organisations (NGOs), to develop evidenced-based recommendations for policy change. Recommendations will be based on cost effectiveness as well as clinical outcomes and will result in changes to surgical practice.

The Committee, chaired by the President of the Royal College of Surgeons (England), includes representation from the WHO, The Lancet Commission and the UK Government as well as International Surgical Societies and NGOs.

The Global Surgery Unit is committed to building and strengthening research capacity in areas specifically relevant to patients in our LMIC partner hub countries.

Each year as part of our annual research prioritisation workshop, researchers from our partner countries are invited to submit research proposals for consideration for seed funding from the Global Surgery Unit.

The best conceived bids receive pump-priming funding together with mentoring from academics at the Unit in order to develop and conduct their research projects. It is anticipated that this initial funding will generate early pilot data leading to future large scale funding to develop and expand these projects to larger studies and trials across the Global Surgery Unit network.

Applications considered for funding to date include task shifting hernia repair from surgeons to technicians in Ghana, stoma care in The Philippines, use of the WHO surgical safety checklist in Rwanda and open verses keyhole removal of the appendix in Nigeria.

Through this funding stream the GSU has also supported educational visits between researchers in our hub countries.

Click here for more information on studies that have been funded through pump-priming surgical research awards

Most clinical guidelines are developed by high‐income country institutions with little consideration given to either the evidence base for interventions in low‐ and middle‐income countries (LMICs), or the specific challenges LMIC health systems may face in implementing recommendations.

We have completed a Delphi exercise to prioritize topics for global surgery guideline development. The results of the Delphi exercise were reported in BJS. We are now working with the research Hub network to develop the top prioritised guidelines. You can read more about this work on our Guidelines page.

Countries registered to take part in GlobalSurg II

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