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‘DISSEMINATE’: a roadmap for facilitating adoption of affordable surgical innovations in low and middle-income countries
  1. Dhananjaya Sharma1,
  2. Vikesh Agrawal1,
  3. Nadia Adjoa Sam-Agudu2,
  4. Pawan Agarwal1,
  5. Sanjay Kumar Yadav1,
  6. Jitin Bajaj3
  1. 1 Department of Surgery, NSCB Government Medical College, Jabalpur, Madhya Pradesh, India
  2. 2 Virology, Institute of Human Virology Nigeria, Abuja, Nigeria
  3. 3 Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
  1. Correspondence to Professor Dhananjaya Sharma, Department of Surgery, NSCB Government Medical College, Jabalpur, Madhya Pradesh 482003, India; dhanshar{at}


Importance Affordable surgical innovations (ASIs) provide simple, safe and equitable solutions in resource-limited settings. Effective dissemination is needed for widespread adoption and uptake of ASIs in low and middle-income countries (LMICs). However, surgical systems in these settings face challenges with adoption and uptake of ASIs, which remain unknown and/or unused even after supporting evidence is published. A surgery-specific, implementation science-informed framework can provide a roadmap delineating the actions needed to achieve this goal; however, none exist currently. This prompted the development of a well-defined roadmap for this purpose.

Methods The roadmap was developed after several rounds of structured brainstorming discussions among the authors, who are LMIC-based experts in academic surgery, ASIs, global health and implementation science.

Results and conclusion The proposed ‘DISSEMINATE’ roadmap presents 18 non-sequential domains to be considered in a comprehensive approach to equitable accessibility for surgical innovations: Design of the innovation; Innovate by combining the IDEAL (Idea, Development, Exploration, Assessment and Long-term follow-up) surgical innovation framework with local multidisciplinary expertise; Substantiate available evidence; Scale up application of evidence in surgical practice; Share knowledge on multidisciplinary platforms; Sustainability; Endorsement of the innovation by local catalysts; Media promotion; Identify early adopters; Improve and refine the innovation; Improvise during setbacks; Implementation science methods; Navigate through barriers; Aspirational affordability; Advocacy for the value of ASIs; Tools for scalability and adoption; Evaluate impact of dissemination; and Extend use of the innovation to resource-rich settings. This surgery-specific roadmap provides structure for effective dissemination to help in overcoming know-do gaps in the use of ASIs in LMICs.

  • general surgery
  • global health
  • socioeconomic factors

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  • Contributors DS conceptualised the article, wrote the first draft of the article and is the guarantor. VA, NAS-A, PA, SKY and JB contributed substantially and revised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.