Improving Surgical Outcomes in Low and Middle-Income Countries through Surgical Technology Innovation

Improving global surgical care is essential to achieve the World Health Organisation’s goal of Universal Health Coverage by 2030. In 2015 the Lancet Commission on Global Surgery recognised that novel surgical technologies and innovations are key enabling factors in this aim. Globally, only 9.8% of surgical technology innovation reach clinical trial and less than 1% achieve widespread adoption. The aim of this Thesis was to investigate how surgical innovation occurs in LMICs, the barriers to innovation, strategies to increase innovation research capacity and capability, and the steps needed to increase the efficiency of clinical translation and adoption of surgical innovation for LMICs globally.

Data from two surgical trials, qualitative studies involving healthcare staff, surgeons, and researchers from within LMICs, and the presentation of a novel Global Surgical Innovation IDEAL Sub-Framework provide a compelling pathway to improve innovation evaluation and adoption in global surgery. By combining literature in the field with a comprehensive range of mixed methodologies, it can be concluded that given the significant barriers, it is important to explore context-specific evaluation approaches, with in-built researcher training and qualitative methodologies along the innovation pathway. Importantly, technology enhanced learning tools such as virtual reality appear feasible in low-resource settings and will be important in addressing the substantial human resource barrier. This work also led to a Sub-Framework that guides the evaluation and appropriate adoption of technology and innovation in global surgery and aims to be widely applicable across contexts. This can now be used to inform future work, in which the Sub-Framework itself can be tested, iterated, and validated in wider populations and contexts, to improve the subsequent dissemination of innovation in global surgery.