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.

中文翻译：

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全球骨科手术推广能力建设框架和蓝图

背景： 

来自高收入国家的非政府组织 (NGO) 为低收入和中等收入国家 (LMIC) 的患者提供外科外展服务；然而，这些努力缺乏对其能力建设能力的协调衡量。虽然世界卫生组织和其他机构推荐旨在建设当地医疗保健系统能力的外展旅行，但没有关于如何实现这一目标的指南。本文的目的是建立一个框架和蓝图，以指导非政府组织的运作，这些非政府组织提供外展活动以在中低收入国家建立骨科手术能力。

方法： 

我们对位于 7 个国家（6 个中低收入国家）的 16 名整形外科医生和管理人员进行了半结构式访谈，就能力建设的必要领域进行了定性分析；该分析以对能力建设框架的文献审查为指导。我们随后与一个由 10 名在全球外科外展方面具有专业知识的美国外科医生组成的联盟进行了修改后的名义小组技术，该联盟由来自 4 个 LMIC 的 8 个新利益相关者进行了成员检查。

结果： 

确定了一个包含 7 个领域的全球外科外展能力建设框架。这些领域包括专业发展、金融、伙伴关系、治理、社区影响、文化和协调。这些域在分层系统中分层，以对每个域的容量级别进行分层。制定了一个蓝图来指导寻求能力建设的组织的运作。

结论： 

开发的框架确定了在全球整形外科外展期间进行能力建设时需要解决的 7 个领域。该框架及其分层系统可用于评估能力并指导中低收入国家的能力建设工作。制定的蓝图可以指导非政府组织开展以能力建设为重点的活动，以确保产生可衡量的持续影响。