Spiegel, D.A.Misra, M.Bendix, P.Hagander, L.Bickler, S.W.Saleh, C.O.Ekeke-Monono, M.Baah-Odoom, D.Caldwell, A.Irons, B.Amir, S.Taylor, R.Layne, M.Hailu, H.Awais, S.M.Price, R.R.Crockett, S.Islam, M.2018-09-112018-09-112015-09doi: 10.1007/s00268-014-2928-x.http://ugspace.ug.edu.gh/handle/123456789/24064BACKGROUND: While surgical care impacts a wide variety of diseases and conditions with non-operative and operative services, both preventive and curative, there has been little discussion concerning how surgery might be integrated within the health system of a low and middle-income country (LMIC), nor how strengthening surgical services may improve health systems and population health. METHODS: We reviewed reports from several meetings of the working group on health systems strengthening of the Global Initiative for Emergency and Essential Surgical Care, and also performed a review of the literature including the search terms "surgery," "health system," "developing country," "health systems strengthening," "health information system," "financing," "governance," and "integration." RESULTS: The literature search revealed no reports which focused on the integration of surgical services within a health system or as a component of health system strengthening. A conceptual model of how surgical care might be integrated within a health system is proposed, based on the discussions of our working group, combined with sources from the medical literature, and utilizing the World Health Organization's conceptual model of a health system. CONCLUSIONS: Strengthening the delivery of surgical services in LMICs will require inputs at multiple levels within a health system, and this effort will require the coalescence of committed individuals and organizations, supported by civil society.ensurgical carelow and middle-income country (LMIC)health systemspopulation healthArticle