Integrating community engagement and involvement in surgical care processes in low-resource settings: a case study from Pakistan

Community engagement and involvement (CEI) is highly recognized as an important factor in providing ethical, effective, and equitable healthcare and medical research. However, in low- and middle-income countries (LMICs), the implementation of the CEI has been limited, especially in surgical systems. In collaboration with the UK’s National Institute of Health and Care Research (NIHR) Global Health Research Group on Acquired Brain and Spine Injury (ABSI) group at the University of Cambridge, this study describes the development, implementation, and initial outcomes of a formal CEI initiative at Northwest General Hospital and Research Centre (NWGH & RC) in Pakistan. The primary purpose of this initiative is to actively engage patients, caregivers, and community members in the development, administration, and management of surgical care, focusing on conditions such as traumatic brain injury (TBI), spina bifida, and burns. Participants were recruited via telephone using records from the hospital system, outpatient services, and community outreach events. The prominent features of the CEI initiative were patient-led podcasts, the co-creation of educational materials, involvement in the review of research ethics, and participation in public awareness and advocacy efforts. These initiatives led to key institutional transformations, such as the integration of CEI principles into Institutional Review Board (IRB) applications. The activities repositioned participants from passive recipients of care to active healthcare advocates and research partners. This CEI model is now recognized as a framework that can be used both locally and internationally and can be reproduced and extended in low- and middle-income countries (LMICs). Adapting to local cultures, utilizing multilingual resources, and maintaining engagement through informal feedback channels are the primary elements that contributed to the success of these practices. A Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis revealed opportunities for growth and skill enhancement, alongside challenges such as limited resources and the potential for participant dropout. The results suggest high potential to enhance the relevance of research, the responsiveness of healthcare systems, and community engagement in surgical care within resource-constrained global environments, if the CEI is carefully managed to fit cultural frameworks and integrated into existing structures. Despite this, future work to assess the long-term clinical outcomes and policy-level impacts of CEI in surgical care is required. Not applicable. People who use medical services are generally not involved in decisions regarding their care or in medical research, especially in low- and middle-income countries. This is particularly true for surgical care, where patient and community opinion are rarely included in planning, research, or governance. As a result, services may not adequately represent the needs and experiences of patients and families. This study describes how a formal Community Engagement and Involvement (CEI) programme was designed and introduced at Northwest General Hospital and Research Centre in Pakistan, in collaboration with researchers from the University of Cambridge. The programme focused on surgical conditions with a severe impact on patients and families, including traumatic brain injury, spina bifida, and burns. Hospital records and community outreach were used to engage patients, caregivers, and community members, who contributed to patient-led podcasts, co-created educational materials, reviewed research ethics processes, and supported public awareness and advocacy. Community involvement was also embedded into routine hospital research and governance systems. Patients and families who were taking part in the programme were able to become active participants in the research and healthcare. Key strengths included improved trust, accountability, and communication between communities and the hospital. Challenges included limited resources and the risk of reduced participation over time. This study shows that people in low-resource settings can be meaningfully involved in surgical care. Community engagement and involvement can make health care and research more relevant when adapted to local culture and built into current systems. Further work is needed to assess long-term clinical and policy impacts.