SPA Doctoral Candidate Yusra Shawar, left, and cover of "The Lancet" journal, right.

An article that examines the prioritization of surgical services on the global agenda was published this month in The Lancet by School of Public Affairs (SPA) doctoral student Yusra Shawar.

The article – titled "Generation of political priority for global surgery: A qualitative policy analysis" – was co-authored by Jeremy Shiffman, a professor in SPA’s Department of Public Administration and Policy (DPAP), and David Spiegel, an orthopedic surgeon and professor at University of Pennsylvania.

“Despite the high burden of surgical conditions and the potential for basic surgical care to reduce this burden, surgical provision remains a low priority on the global health agenda,” said Shawar, a Ph.D. student in DPAP. “Our research investigates this puzzle.”

Specifically, she said, her team examined the factors that shape political priority for global surgical care. The article presents both challenges and opportunities, with the aim of sparking productive discussion among the global surgery community.

Shawar said that a lot of work has to be done to get proper surgical services for people around the world, especially in low and middle-income areas.

First, she said, an effective governance structure needs to be built that links people working on the issue and promotes effective collective action. Currently, surgeons and others who have worked to advance the cause widely understand present structures to be inadequate, causing frustration and mistrust. 

Shawar said that consensus also needs to be reached on solutions in the global surgery community. Although there is agreement regarding problem definition—that surgical care is a grossly neglected issue—disagreements persist regarding what needs to be done, she said.

Lastly, Shawar said, public positioning of this issue needs to resonate with existing positions of policymakers and other stakeholders, with particular attention to overcoming prevalent misperceptions surrounding the cost and complexity of surgery.

Shawar and her team presented the findings in multiple conferences, including the World Congress of Surgery, Obstetrics, Trauma, and Anesthesia (Trinidad & Tobago, 2013); the Association for Public Policy Analysis and Management annual conference (Washington, D.C., 2013); John Hopkins University’s Film Screening and Discussion: The Right to Heal (Baltimore, 2014); the first Lancet Commission on Global Surgery Meeting (Boston, 2014); the Consortium of Universities for Global Health annual conference (Washington, D.C., 2014); and the International Studies Association annual conference (New Orleans, 2015).