NIHR Global Health Research Unit on Global Surgery: Establishing a Sustainable Network of Surgical Research

Background: The NIHR Global Health Research Unit on Global Surgery (GSU) initially funded in 2017, established 7 surgical research Hubs (Benin, Rwanda, Ghana, India, Nigeria, Mexico, South Africa), coordinating research through more than 70 ‘Spoke’ hospitals across 3 continents, prioritised through LMIC led Delphi processes (2016-20).

Research completed: A global randomised trial (RCTs) in wound infection prevention (5800 patients), second recruiting (11,000 patients), 4 prospective cohort studies (150,000 patients), 3 modelling studies, 7 pump-priming studies, 4 qualitative studies, 3 CEI projects and 2 guidelines, publishing 28 peer reviewed papers from this work.

Proposal: In this funding envelope we will seek excellence through a new body of prioritised primary research, equitable partnerships through transfer of research leadership to the Hubs, sustainability through new Hub-based training centres. We will achieve this across 4 domains: Domain 1: Research

• Interventional: Practice-changing evidence to rapidly evaluate healthcare technologies to improve patient outcomes; with focus on postoperative mortality and surgical infection. We will complete 2 new global RCTs, selected from 4 pilot RCTs (completed by 2022).

• Observational: Themed around transforming systems of care, 4 projects will aim to strengthen whole health-system resilience for the surgical patient by: (i) Improving access to emergency surgery by applying health economic models (ii) Using data to support decision making in the post-pandemic recovery period

(iii) Developing research questions for a new integrated rural surgery network (iv) Hub-led cohort studies targeted towards local priorities Domain 2: Education and Training

Establish sustainable research capacity through new Hub-led and delivered training and education programmes. These will be delivered by bespoke Training Centres, responding to LMIC training needs, facilitating South-South collaboration and be accessible to other global health researchers. 3 bespoke Training Centres are proposed:

• Surgical Research Skills: Providing postgraduate training programmes (23 MSc & PhDs). • Data Training: Embedded digital technology, data management, and analysis capability.

• Management Training: To provide holistic research management support through the entire research programme lifecycle Domain 3: Community Engagement and Involvement (CEI)

To date, we have established pathways into local communities by co-producing specific research projects with patient partners. Over the next 5-years, we will establish flexible, context-specific, and sustainable local CEI Steering Committees, coordinated through each Hub. CEI will be integrated into research prioritisation, research design and delivery, and act as a pathway to disseminate research to stakeholders.

Domain 4: Impact

We are seeking to deliver practice change to benefit patients across continents, through high-quality research. This will be achieved through three key mechanisms, reaching from the individual patient through to international policy teams: • Health service delivery through patient groups and clinical workers

• Informing national guidelines reaching national surgical societies, health service providers • Multi-stakeholder dissemination of our outputs globally, with integrated impact assessment. Our impact will be evaluated and adapted during the programme, to begin sustainable transfer of ownership to the Hubs.