Opinion: Why international surgical charities must rethink their approach

For decades, international surgical charities, largely from high-income countries, have flown into low- and middle-income countries on short-term missions to deliver essential surgical care. These “fly-in, fly-out” models have undoubtedly provided critical, even life-changing services to patients who might otherwise go without. But while the scalpel can heal a cleft lip in a single procedure, these missions often miss the opportunity to address a deeper systemic need: Strengthening health systems so communities can sustainably care for their own.

Today, the global development landscape has shifted. Communities are demanding not just charity, but partnership. The days when organizations could arrive, operate, and leave without strengthening local systems should be over. Many organizations make bold commitments to “locally led initiatives” at conferences and in press releases, but the gap between promise and practice is glaring. Challenges within organizational leadership, restrictive donor funding, and entrenched systems often block progress toward truly local ownership of surgical care.

Yet the need for change has never been clearer.