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BACKGROUND: Nongovernmental organizations (NGOs) from high-income countries provide surgical outreach for patients in low and middle-income countries (LMICs); however, these efforts lack a coordinated measurement of their ability to build capacity. While the World Health Organization and others recommend outreach trips that aim to build the capacity of the local health-care system, no guidance exists on how to accomplish this. The objective of this paper is to establish a framework and a blueprint to guide the operations of NGOs that provide outreach to build orthopaedic surgical capacity in LMICs. METHODS: We conducted a qualitative analysis of semistructured interviews with 16 orthopaedic surgeons and administrators located in 7 countries (6 LMICs) on the necessary domains for capacity-building; the analysis was guided by a literature review of capacity-building frameworks. We subsequently conducted a modified nominal group technique with a consortium of 10 U.S.-based surgeons with expertise in global surgical outreach, which was member-checked with 8 new stakeholders from 4 LMICs. RESULTS: A framework with 7 domains for capacity-building in global surgical outreach was identified. The domains included professional development, finance, partnerships, governance, community impact, culture, and coordination. These domains were tiered in a hierarchical system to stratify the level of capacity for each domain. A blueprint was developed to guide the operations of an organization seeking to build capacity. CONCLUSIONS: The developed framework identified 7 domains to address when building capacity during global orthopaedic surgical outreach. The framework and its tiered system can be used to assess capacity and guide capacity-building efforts in LMICs. The developed blueprint can inform the operations of NGOs toward activities that focus on building capacity in order to ensure a measured and sustained impact.

Background: Global outreach to low- and middle-income countries (LMICs) continues to grow in an effort to improve global health. The practice of quality measurement is empirically lacking from surgical outreach trips to LMICs, which may limit the safety and quality of care provided. Using convergent mixed-methods, we aimed to: (1) identify and evaluate barriers and facilitators to outcome measure collection; and (2) report the sample rate of such collection on hand surgery outreach trips to LMICs. Methods: Surgeons and administrators involved in hand surgery outreach trips completed a survey regarding rates of outcome measure collection and a semi-structured interview to explore barriers and facilitators of outcome collection. Survey data were reported descriptively. Interviews were recorded and transcribed, and excerpts were categorized according to the Pettigrew framework for strategic change (content, process, and context). Results were combined through convergent mixed-methods analysis. Results: Thirty-three participants completed the survey, and 21 participated in interviews. Rates of collection were the most common for total case number (83%) and patient mortality (65%). Longitudinal outcomes (eg, patient follow-up or time away from work) were less frequently recorded (9% and 4%, respectively). Content analysis revealed barriers related to each domain of the Pettigrew framework. Conclusions: This analysis demonstrates low levels of outcome collection on outreach trips and identifies priority areas for improvement. Developing context-specific solutions aimed at addressing barriers (eg, resource/database availability) and promoting facilitators (eg, collaborative relationships) may encourage higher rates of collection, which stands to improve patient safety, quality of care, and accountability when conducting outreach trips to LMICs. [ABSTRACT FROM AUTHOR]

Coal resources have always been an important driving force for macroeconomic growth and GDP growth in resource‐rich regions. However, this growth has also caused inequality of household income in developing regions. Using survey data on rural household livelihoods in Shenmu county, Shaanxi Province, in northwestern China, this paper analyzes the relationship between coal exploitation and income inequality. Four multivariate econometric analyses are developed. We find evidence for the resource curse theory of natural resource exploitation leading to inequality: the Gini coefficient for household revenue is discovered to be markedly related with the location of and participation in coal exploitation. Nevertheless, this correlation is not linear. Rather, household income inequality primitively rises with environmental and resource subsidies. We analyze the impacts of household income inequality and contrast the characteristics of household livelihood and location characteristics in the coal exploitation site of northern Shenmu with those in the whole survey site. Our statistical analysis shows that out‐migration, the level of total household income, and convenience of household transportation are the important elements devoting to household income in northern Shenmu, the coal resources endowment region. However, the environmental damage and pollution caused by coal exploitation has substantial negative impacts upon household income, especially for households not participating in coal activities. Overall, we found that coal exploitation did not develop local industries. Adversely, the ecological environment problem and the high subsidy for coal mining caused by the exploitation of coal resources have aggravated the inequality of household income in the sample areas. Additionally, the development of coal resources attracted youth labor from agriculture to the coal industry, which exacerbated the lack of labor force and weakened village agricultural productivity. [ABSTRACT FROM AUTHOR]