Introduction​

Nearly two decades ago, Farmer and Kim famously declared surgery “the neglected stepchild of global health” (1). Three years ago, Farmer stated that “surgery, obstetrics and anaesthesia have lost this title and are now the most exciting parts of global health equity.” (2). This bold declaration meant that while the global community had finally made some progress toward achieving equity in global surgery at the international level, the global surgery advocates had not yet achieved the goal of the movement to ensure access to quality essential surgical and anesthesia care for under-resourced communities. To achieve global health equity, surgical advocacy must transition from international declarations to grassroots action, empowering frontline providers and integrating surgery into national health priorities (3, 4).
The term “advocacy” can conjure up thoughts of rallies and marches, intensive media campaigns, meetings with legislators, and the potential for backlash. Not many surgeons have experience in advocacy, and those with some experience typically concentrate on issues such as payment reform or regulations (5-7). Highly skilled advocates often operate in silos. Plastic surgeons have responded to the demand for safe, affordable care by facilitating short-term surgical programs involving 180 plastic surgery nongovernmental organizations (NGOs). This has brought attention to the critical need for improved plastic surgery access in low- to medium-income countries (LMICs), generating public support and encouraging policymakers to prioritize surgical initiatives like raising awareness (8).
Advocating for changes to policy or legislation requires significant effort and takes time. Making time to fill a seat on one committee often means leaving an unfilled seat someplace else. Allocating time for the myriad duties of a surgeon often is a game of musical chairs that requires prioritizing patient care at the expense of advocacy-related efforts that would also benefit patients and influence important positive policy changes. However, complex healthcare systems, policy landscapes, rising societal challenges, and global shifts have underscored the need for surgeons to expand their advocacy scope beyond the operating room. This involves allocating resources, seeking research grants, supporting policies that facilitate surgical care, raising public awareness of surgical requirements, and promoting research and training within surgical societies (5, 6).
This editorial piece highlights the significance of advocacy for surgeons as an individual, as part of a surgical society, and within a group of surgical societies speaking as one voice. Written from personal experiences by a former Surgical Society of Kenya (SSK) President, who is also the current Chair of the Council of Chairs of Surgical Societies (CCSS), the piece outlines lessons learned on providing leadership in unifying surgical societies to speak as one voice. The article elaborates advocacy options for surgeons as individuals, as surgical teams, and as members of different surgical societies, offering tips on communicating with leaders. It also mentions the American College of Surgeons’ (ACS) international advocacy role and proposes the use of the ACS model by local surgical societies as a benchmark to embed surgical health advocacy for the sake of achieving global equity.

How can a Surgeon be an effective advocate of global health equity?
Effective advocacy requires surgeons to be well-informed, objective, and collaborative, working with various stakeholders to achieve positive change. Advocacy efforts may face opposition, but maintaining objectivity, respectful dialogue, and transparency can help navigate these challenges.
Inexperience can be a significant barrier, with new surgeons often lacking the confidence, skills, and knowledge needed to effectively advocate for their patients and healthcare systems. To address this, training programs are emerging to equip less-experienced surgeons with the advocacy capabilities necessary to influence policy, promote global health equity, and ensure the highest quality of surgical care for all. Many universities have started Academic Global Surgery programs that include advocacy electives, which aim to provide surgical and anesthesia care providers in LMICs with skills to be advocates for surgical care within their communities and globally (6, 7).
Financial burden is also one of the key barriers to advocacy efforts. Fundraising efforts and strategic partnerships can help overcome these challenges. Recently, SSK has secured grants, prompting affiliate surgical societies to collaborate with SSK for potential member benefits.

Individual advocacy efforts and as surgical teams in Kenya.

Surgeons have a vital role in advocacy, which extends beyond the operating room. This includes resource allocation, sourcing for research grants and advocating for policies that support surgical care, increasing public awareness of surgical needs, promoting research, and training in surgical societies (5, 6). Some key areas of advocacy efforts by individual surgeons and surgical teams in Kenya have been highlighted below. They include the following:​

1. Social media, campaigns, podcasts, workshops, conferences, and print media
   a.Dr. Nicholas Okumu, an orthopedic oncological expert, a global health graduate, and a columnist in “The Star” (a local daily newspaper), is an aggressive advocate for healthcare reform and leadership in Africa.
   b.Dr. Keith Dindi, a cardiothoracic surgeon and the chair of the Kenya Association of Thoracic Surgeons, passionately speaks at every conference platform about “A Symphony of Hope: Building Cardiac Surgical Units in Resource-limited Settings”. His effort and voice in championing progress in cardiothoracic surgery, especially in sub-Saharan Africa, has been unrelenting with a tune of “Changing the world, one heart at a time” with the overall aim of achieving global health equity for cardiac surgical patients.
   c.Breast surgeon oncologists Prof. Miriam Mutebi (who is also the chair of SSK oncology committee and the President of the African Organization for Research and Training in Cancer) and Dr. Karen Mbaabu (who is also the current SSK treasurer) are both passionate advocates for the optimal management of breast cancer in Africa. They have been doing this, together and as individuals, through their social media handles (such as LinkedIn and X), print media, podcasts, small-group discussions, workshops, and conference presentations.

2. Public health policy and training
   a.Prof. Moses Obimbo, a Bill Gates Foundation grant recipient, a distinguished translational science scholar, END PPH (postpartum hemorrhage) Project Lead, and the Honorary Secretary of the Kenya Obstetrical Gynaecological Society (KOGS), has used part of the Gates grant to address postpartum issues to enhance the safety of childbirth. With the support of KOGS leadership and Prof. Julius Ogeng’o, he has been diligently advocating for policy reforms and collaborative efforts using his social media handles and country-wide activities.
   b.Dr. David Karuri, the chair of the SSK trauma committee and the founder of the BladeDoc Network (an umbrella body that seeks to train, innovate, and improve bikers’ safety). In partnership with SSK, Stopthebleed.org, the ACS, MP Shah Hospital, and Lions Club Peponi, the “BladeDoc Network” has held several training sessions for boda boda (motorcycle) riders who are usually the first responders in any scene of road accidents. These sessions not only showed them how to manage emergencies in case of road accidents but also motivated them to learn more about road safety practices. In turn, this has provided a strong advocacy platform that may influence policy change and assist in reducing the road carnage that we see in Kenya.
   c.Dr. Stanely Aruyaru and Dr. Caesar Biita, both executive members of the current SSK council, consistently advocate the importance of surgeons adopting the role of physician executive. Each of them has been doing this through their social media handles, print media, podcasts, and small-group discussions. Their objective is to ensure that clinical governance remains central to decision-making in all healthcare institutions. As highlighted by Dr. Stanley Aruyaru’s social media presence, “the hallmark of successful physician anchor leadership is when clinical governance is fully integrated not only into policies and reports, but also into institutional strategy.”

3. Scientific research
   a.Dr. James Kigera, an orthopedic surgeon and the editor-in-chief of Annals of African Surgery, routinely organizes training sessions for surgeons and surgical trainees to learn how to write impactful scientific articles that can be published in peer-reviewed journals for advocacy purposes.
   b.Dr. Philip Mwachaka, a neurosurgeon and the editor-in-chief of East African Journal of Neurological Sciences, advocates using scientific journals, school events, and surgical camps to promote the optimal management of brain tumors and minimally invasive neurosurgical procedures.

4. Outreach camps
   a.Dr. Joe Njagi, Dr. Yamal Patel, Dr. Dennis Mureithi (Laparoscopy on Wheels), Dr. Bernard Ndung’u, and Prof. Pankaj Jani (pioneer laparoscopist and endoscopist) have each participated in community-based free laparoscopy surgical camps. These events have provided opportunities for advocacy, mentoring, and training surgeons in minimally invasive surgery. They have also been doing this through their social media handles, print media, small-group discussions, and workshops.

5. Ethical considerations
   a.Advocating for ethical and responsible surgical practice is paramount. This includes promoting transparency, accountability, and patient-centered care. As part of the SSK community, surgeons can collaboratively navigate ethical dilemmas related to work ethics, resource allocation, informed consent, and end-of-life care. Prof. Daniel Ojuka, a former SSK president, who serves as a member of the Kenyatta National Hospital—University of Nairobi (KNH-UoN) Ethics and Research Committee actively pursues this initiative.

6. Physician well-being
   a.Advocating for supportive work environments and resources that promote surgeon well-being is important. This includes promoting stress management techniques, access to mental health support, and policies that reduce burnout among surgeons. Dr. Elizabeth Okemwa, a surgical educator, uses her presence in the media to strongly advocate on good, structured mentorship and coaching during residency. This advocacy will go a long way in directing policy change in the surgical work environment.

SSK Collaborations and Partnerships

SSK routinely partners with many stakeholders in the private sector and NGOs to carry out annual surgical camps in underserved communities in different counties. These include Narok (2004), Kapenguria (2012), Coast (2023), Nairobi, Kiambu, Narok (2024), and Makueni (2025) (Figure 1). Some of the key partners included the county government leadership, Rotary Club of Nairobi Magharibi, Lariox Healthcare, Proximie, Kenya Society of Anaesthesiologists (KSA), Laparoscopy on Wheels, and Kenya Society for the Blind, among others. These surgical camps have raised awareness of available surgical expertise and services while positively impacting the community. 

 

Figure 1.

A slide capturing the unique collaboration of surgical societies with the Government of Makueni and others to register an unprecedented number of surgeries. Thanks to the robust grassroots advocacy efforts that preceded the event.

They have also prompted opinion leaders and policymakers to critically consider implementing global surgery goals at the local level.
Partnerships with Leeds University, Proximie, and Loresa have assisted in successful joint applications for grants for training and research for cost-effective innovative laparoscopy tools in resource-poor settings. Dr. Michael Mwachiro and I have been the SSK leads in the establishment of an SSK digital community of practice (dCoP) to support sustainable innovative solutions to improve access (through telepresence) for optimal surgical care to the underserved community using the cutting-edge technology to strengthen the capacity of the Kenyan surgical workforce. Lariox Healthcare, Meril Academy, and Prota have in one way or another also assisted SSK to subsidize training opportunities in laparoscopy, endoscopy, vascular, laser anal surgery, and in the operationalization of dCoP. Global health partnership SCALE grant and GlobalCARE grants have been very useful in subsidizing vascular training series at the NSSC. SSK has been strategically leveraging the dCoP to advocate for increased political attention to surgery at the county and national level. 

 

How can Surgical Societies influence Health Policy through advocacy?

Surgical societies play a significant role in shaping health policy by advocating for quality surgical care, influencing legislation, and promoting evidence-based practices. They act as a collective voice for surgeons, enabling them to address challenges within the healthcare system and contribute to broader health policy discussions (9, 10).
The ACS is a classic example of a professional organization whose voice actively lobbies for policies that support surgeons and their patients, focusing on issues like patient safety, access to care, and quality improvement initiatives. They have made advocacy a component of their core mission, playing an active role in civil society on multiple levels. These various levels of involvement may range from grassroots efforts at the local level to address specific community needs, to political activism at the national level, where engagement with legislators can influence policy (11).
The ACS representatives provide expert testimony before legislative committees and regulatory agencies to share their knowledge and perspectives on proposed policies. The ACS collaborates with other healthcare organizations, patient advocacy groups, and professional societies to advance shared policy goals.

Collective advocacy leadership by members of Surgical Societies in KenyaSince their founding in 2024, Surgical Specialties Group (SSG) and CCSS have helped bring together nearly 2300 Kenyan surgical specialists, about a third registered with surgical societies, to support unified advocacy and equity in global surgery, especially concerning regional policy changes. The first SSG meeting held in February 2024 gave the green light for the formation of the SSG Core Team, which was later renamed the CCSS (Figure 2). 

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Figure 2.

A commemorative photo after the meeting of the Chairs of Surgical societies, that inaugurated the Surgical Specialties Group (SSG) Core Team which was later renamed the Council of Chairs of Surgical Societies (CCSS). This brainstorming session was held at the SSK offices in Menelik Medical centre in February 2024.

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The CCSS consists of chairs of the following societies: SSK, Kenya Orthopedic Association, KSA, Association of Oral & Maxillofacial Surgeons of Kenya, KOGS, East African Association of Neurological Surgeons, Neurological Society of Kenya, Kenya Ear Nose & Throat Society, Kenya Association of Urological Surgeons, KAPS, Ophthalmological Society of Kenya, KATS, and Kenya Society of Plastic, Reconstructive & Aesthetic Surgeons.
Following its formation, CCSS held its first meeting to brainstorm and delve deep into the current challenges facing the regulation of surgical practice plus categorization of surgical specialties. Some of the SSG members, which included past presidents of SSK, Prof. Peter Nthumba and I, were fortunate to be invited to attend the inaugural Pan African Surgical Conference held in Rwanda. This important event, which was heavily sponsored by Operation Smile and the Government of Rwanda, attracted surgeons from all over the continent. As the first chair of CCSS, I joined a panel of experts to discuss effective public–private partnerships and innovative approaches to improving surgical access. The conversation was very interactive, insightful, and engaging.

On May 1, 2025, a small team of the CCSS held a breakout session at Forodhani room with a few members of the “Senior Surgeons Caucus,” who were attending the SSK Jubilee celebrations at the Sarova Whitesands Beach Resort & Spa Hotel (Figure 3). The conversation was cordial and inspiring. The agenda was centered on “how they would love to see SSK and the other surgical societies, in the next 25 years”, act as drivers for improving access to surgical care in Africa.

 

Figure 3.

A commemorative photo of a meeting between the Senior Surgeons Caucus and some members of the Council of Chairs of Surgical Societies (CCSS), after a brainstorming session, during the SSK Jubilee celebrations held in May 2024 at the Sarova Whitesands Hotel.

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The meeting noted two realities:

1. Despite being essential to health systems, surgical care remains politically underrepresented and financially under-resourced in Kenya and across Africa.

2. As global funding shifts and local pressures increase, there is a need for clear, coordinated advocacy that reflects ground realities and positions surgery at the heart of policy and funding conversations.

The meeting resolved the following:
SSK in consultation with other surgical societies should collaborate with strategic forums (such as County CECMs, Ministry of Health, Africa CDC, AU, World Bank, Sovereign Wealth Funds, etc.) and develop a unified Africa-led surgical policy development that will drive the future of global surgical equity on the continent.

The CCSS has issued several joint media communiqués on surgical practice in Kenya, and in addition, co-authored letters with the KMA to MoH leadership on matters relating to the scope of surgical practice. Some members of CCSS have also given their time voluntarily to participate for over a year in several stakeholder meetings while contributing to the development of the National Strategic Surgical Plan and guidelines. The strategic plan, heavily supported by Operation Smile and the Government of Kenya, is currently being refined prior to its anticipated launch.
 

References

1.  Farmer PE, Kim JY. Surgery and global health: a view from beyond the OR. World J Surg 2008; 32:533–6.

2. University of Global Health Equity. ‘I am delighted to tell you that you have lost your title as the neglected stepchild of global health, we now see surgery as the most exciting part of global health equity.’ Prof. Paul Farmer, #UGHE’s Chancellor #GlobalSurgery #CEGS #EquityInSurgery, 2022. Available: https://twitter.com/ughe_org/ status/1491053630048583681.

3. Farrer L, Marinetti C, Cavaco YK, et al. Advocacy for health equity: a synthesis review. Milbank Q 2015; 93:392–437. 

4. Vervoort D, Bentounsi Z. Incision: developing the future generation of global surgeons. J Surg Educ 2019; 76:1030–1033. 

5. Chelsea Dorsey, Simi Ogunnowo, Anthony Douglas, et al. Surgeon as advocate: A widening lane, Surgery, 2025; 185:109515, 

6. Jumbam DT, Bustamante A, Alayande BT, et al. To advance global surgery and anaesthesia, train more advocates. BMJ Glob Health 2023; 8: e012848.

7. Vaghaiwalla T, Gyawali S, Jayaram A, et al. Advocacy committee of the association for academic global surgery. Academic global surgery: creating opportunities, equity, and diversity. Ann Glob Health 2023; 89:12. 

8. Alice U, Kanmounye US, Jumbam DT, et al. Global Surgery Speaker Series: An Education and Advocacy Resource for the Advancement of Global Plastic Surgery. Plast Reconstr Surg Glob Open. 2024 Sep 10;12(9):6144.

9. Zadey S, Sharma D, Cotton M. Advocacy for surgeons: Ensuring excellence in patient care. Tropical Doctor. 2024;54(2):85-87. 

10. Surgeon advocacy in action: Challenges, accomplishments, and future direction. ACS website.

11. Surgical societies: Their impact on health policy. ACS website. 

12. Jumbam DT, Kanmounye US, Alayande B, et al. Voices beyond the Operating Room: centring global surgery advocacy at the grassroots. BMJ Global Health 2022;7: e008969.