Work

Capacity building initiatives in orthopaedic outreach: A barrier-strategy mapping tool

Year: 2026

Type: article

Abstract: Background The disparity between surgical demand and clinician availability in low- and middle-income countries (LMIC) represents a global health challenge, contributing to preventable morbidity and mortality. Although non-profit organizations can perform short-term outreach trips to address immediate needs, their temporary nature may fail to achieve sustained impact. Formal capacity building initiatives, which aim to empower local health systems to independently address unmet surgical demands are needed. This study aims to 1) identify the barriers/facilitators to capacity building in orthopaedic surgical outreach and 2) match targeted implementation strategies that can enhance the effectiveness of these initiatives. Methods We conducted semi-structured interviews with 20 stakeholders from LMIC and high-income countries (HIC) from six organizations with experience in over 44 countries to identify barriers/facilitators to implementation of capacity building initiatives. Interview transcripts were analyzed using the Consolidated Framework for Implementation Research (CFIR). The Expert Recommendations for Implementing Change (ERIC) mapping tool was used to match barriers with implementation strategies. We subsequently conducted a modified nominal group technique with a consortium of seven surgeons with global surgical outreach expertise to evaluate each strategy's feasibility, cross-context applicability, and prioritization. Following discussions, panelists independently voted on the strategies, requiring a ≥80% consensus for inclusion. Results A total of 34 barriers and 31 facilitators to implementation were identified. Examples of barriers included high cost and lack of an implementation leader while facilitators included longitudinal partnerships and access to technology. 38 strategies were matched to these barriers. Examples of strategies include identify and prepare champions, conduct educational meetings, and conduct local needs assessments. Conclusions This study highlights common barriers to the implementation of capacity building efforts in global surgical outreach and provides a strategy matching tool for capacity building initiatives. Utilization of these strategies improve implementation, ultimately supporting the long-term success and effectiveness of capacity building in LMIC.

Source: Journal of Orthopaedic Reports

DOI: 10.1016/j.jorep.2026.100923