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global engagement requires familiarity with the concept of decolonization (see Chap. 3). In the context of global health, decolonization is broadly dened as an effort to shift away from thehistorical dynamics of power and dominance to implement equitable systems to improve pop­ulationhealth [7]. Recently, attention has been drawn to a dichotomy in global health, where global health organizations have historically lacked diversity and inclusivity, mirroring the society and values of Western high-income countries while maintaining a xation on inter­vening in LMIChealth systems [8]. Thedecolo­nization movement calls for the autonomy of previously underrepresented nations to build and sustain theirown health systems and work­force, as well asincrease inclusiveness of these nationsin conversations within the global health community [9]. CHESA engages in all of its activities with these practices and prioritiesat the forefront.

increase in number, creating a network of centers in high-, middle-, and low-income countries focused on addressing both local and global healthcare challenges. In South Africa, an upper­middle income country, the Centre for Global Surgery was established in 2019 within Stellenbosch University. This center works toward promoting equitable surgical care in South Africa and sub-Saharan Africa through high-quality research, policy maker engagement, and education, with an overall mission to be a global surgery research center of excellence with collaborations within and outside South Africa [12]. Similarly, the University for Global Health Equity (UGHE) was created in 2019in Rwanda, a low-income country. Initially envisioned by Partners in Health (PIH) in 2014 to build a uni­versity that would advance global health deliv­ery, the university focuses on training future global health leaders and equipping them with the necessary skillsets to build effective, lasting, and equitable health systems. As of 2021, their programs included Bachelor of Medicine, Bachelor of Surgery, Master of Science in Global Health Delivery, Executive Education, and an Institute of Global Health Equity Research [13]. Specic to surgery, UGHE has a Center for Equity in Global Surgery, whose mission is to “create equitable access to quality, safe, and holistic surgical, obstetric, and anesthesia care for vulnerable populations provided through integrated, compassionate, and community-cen­tric approach,” with a focus on empowering local leaders and solutions [14]. The Harvard Program in Global Surgery and SocialChange (PGSSC) is an example of an academic global surgery center in the USA, a HIC. PGSSC’s mission advocates for “universal access to safe, afford­able surgical, anesthesia, and OB/GYN care when needed.” The Harvard Program exhibits its mission in surgical and health systems strength­ening (i.e. fellowship) [15]. Additional aca­demic global surgery programs in the USA include The Center for Global Surgery at the University of Utah [16] andthe Global Surgical Track in the general surgery residency pro­gram at Baylor College of Medicine [17], among others in the USA, Canada, and across the globe.

The Center for Health Equity in Surgery and Anesthesia, abbreviated CHESA, is a center based at the University of California, San Francisco (UCSF) within the University’s Institute for Global Health Sciences (IGHS). Led by the efforts of a sur­geon and anesthesiologist at UCSF,as well as addi­tional championing faculty, and the support of partners at Makerere University (MU) in Uganda, CHESA ofcially launched in March 2020 during the beginnings of the COVID-19 pandemic. The name of the Center is reective of the global health equity focus of the group and the inclusion of the wide range of professionals working within surgery, anesthesia, and perioperative care. Inclusive of all related elds, current CHESA members represent anesthesiology, general surgery and surgical sub­specialties, dermatology, nursing, pathology, public health, obstetrics and gynecology, and biostatistics, among others and with new additions continually welcomed.

IGOT was founded in 2006 with the goal of addressing global disparities in orthopedic trauma care. IGOT’s agship innovation is the IGOT SMART (Surgical Management and Reconstructive Training) course. This course provides orthopedic surgeons in resource-limited settings with the skills to successfully perform surgeries to reduce the incidence of amputations. Through the IGOT Portal, educational material and the SMART course are available anywhere in the world with an online classroom format. IGOT and CHESA are active partners in distributing advanced educational tools and resources [21]. Health, Equity, Action, and Leadership Initiative (HEAL): Based in UCSF, HEAL’s mis­sion is to have health professionals train and practice in settings with vulnerable populations, both in the USA and internationally. The HEAL fellowship has two tracks, one track for “site fel­lows” who have roots in a HEAL partner site or community they currently serve and an alterna­tive track for “rotating fellows” who rotate over two years. HEAL’s initiatives aim to strengthen and bolster established yet underserved health­care systems. In alignment with this mission, HEAL fellows are embraced as CHESA fellows, sharing the guiding principles of justice, solidar­ity, and equity throughout their work [22].

Other essential skill sets to satisfy the global surgical competencies can be obtained within an equipped academic institution [40]. At UCSF, the Department of Epidemiology and Biostatistics provides robust, rigorous courses for learners to hone clinical research skills. Students can select from a myriad of topics. These can be enrolled as standalone classes, as fulllment toward an Advanced Training in Clinical Research certi­cate, or as part of a Public Health Masters or Doctorate degree. An academic global surgery center can partner with these departments to cre­ate a pathway for trainees to take advantage of valuable educational experiences that may be dis­tinct from the realm of surgery-specic knowledge.

demic global surgery center. Research-related resources are not equitably distributed between high- and low-resource settings. Researchers from LMICs and domestic resource-denied com­munities face multiple roadblocks to performing quality investigations, ranging from minimal “protected time” to weak academic visibility to a general shortage of resources. The paucity of funding is a major limitation in the growth of research capacity in LMICs and domestic resource-constrained areas, as local institutions are often unable to support global surgical research, especially if it has not been made a local or national priority. In fact, the dearth of funding begets a dearth of accessible, reliable data to inform public health priorities, which in turn exacerbates the lack of research capacity in resource-denied settings [42].