Cost of Equipping First‐Level Hospitals for Children's Surgical Care in Low‐ and Middle‐Income Countries

Objective The Global Initiative for Children's Surgery (GICS) developed the Optimal Resources for Children's Surgical Care (ORECS) recommendations to address disparities in access to high‐quality children's surgery in low‐ and middle‐income countries (LMICs). However, the cost of adequately equipping these hospitals is currently unknown, creating a barrier for investments. The aim of this report is to provide a comprehensive costing to direct and support investments to scale up access to care. Methods We conducted a multi‐country cost analysis to estimate the investment required to equip first‐level hospitals in LMICs with essential resources for pediatric surgery. Data were collected from vendors in 17 countries using a survey based on the ORECS framework. Equipment prices were standardized to 2024 international dollars (I$) using World Bank Purchasing Power Parity (PPP) conversion factors. Cost variations across regions were analyzed. Results Vendor response rates were highest in Sub‐Saharan Africa (50%), with variability in questionnaire response completeness across regions, ranging from 97% in Sub‐Saharan Africa and 95% in Europe and North America to 9% in Latin America and the Caribbean region. In the Sub‐Saharan Africa region and Europe and North America region, the estimated mean total costs for equipping first‐level hospitals were I$910,501 and I$796,941, respectively. Major cost drivers included operating tables and C‐arm X‐ray systems. Conclusions Capital investments are required to equip first level hospitals in LMICs to provide children's surgical care. While the upfront costs may be substantial, they are fiscally achievable and sustainable with significant economic and social returns on investment. These cost estimates provide a reference case to guide investments to improve surgical care for children.