Can diaspora-led organisations play a prominent part in global surgery?

The high number of trained staff in countries with a disproportionately small burden of disease has exacerbated inequalities in global health and surgery. It is estimated that in low-income countries there is a shortage of about 2·5 million members of staff , including surgeons and midwives, to provide essential health interventions. Better fi nancial and education opportunities have been cited as common incentives for workers to emigrate, with risk of conflict and disease threatening their safety and security in their own countries. By training providers who later migrate overseas, lowincome countries are losing more than $500 million each year as they effectively subsidise their wealthier counterparts. D i a s p o r a l e d o r g a n i s a t i o n s (DLOs) can have an important role in addressing unmet surgical need in low-income and middle-income countries. These organisations have the unique advantage of being able to relate to the cultural sensitivities of local populations, which is particularly pert inent with mult ifaceted conditions such as obstetric fi stula. In many ways, obstetric fi stula represents a microcosm of the international community’s failure to emphasise the need for cost-effective surgical interventions, and the inability to encourage community-level initiatives that empower women. Although maternal mortality has almost halved over the past two decades, there exists a need to address underlying social causes such as early marriage, which substantially contribute to maternal morbidity. By facilitating clinical and reproductive sexual health programmes for women in rural Bangladesh, DLOs such as Selfl ess are well placed to achieve this. DLOs are better able to expand community links and develop longterm partnerships, contributing to a more meaningful collaboration between high-income and low-income countries. In an era of globalisation, policy makers must capitalise on this underused resource by supporting diaspora communities to improve care in their countries of origin. In so doing, this support will not only alleviate the burden of the so-called brain drain but also address widening inequalities in surgical care. If low-income countries do not address such issues by seeking solutions from within its own communities both at home and overseas, they will struggle to achieve sustainability in the post-2015 agenda.