{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T13:52:48Z","timestamp":1791121968777,"version":"4.1.0"},"reference-count":32,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T00:00:00Z","timestamp":1791072000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T00:00:00Z","timestamp":1791072000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Digital technology holds transformative potential to address barriers to safe and timely surgical expertise and surgery in low\u2010resource settings, where shortages of specialists, fragmented referral systems, and limited infrastructure remain significant challenges. In 2018, Malawi launched a managed surgical clinical network (MCN) in the Southern region, utilizing a structured mobile technology platform to link non\u2010specialist district clinicians with tertiary\u2010level surgeons. Following the conclusion of donor funding in 2022, the MCN has continued to operate under full local stewardship. This study assesses the functionality and potential scalability of the network 1\u00a0year after this transition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A prospective study was conducted of all district\u2010to\u2010central hospital MCN consultations between January and December 2023. Anonymized data were extracted from digital transcripts and analyzed descriptively and inferentially, including case characteristics, timing, clinician participation, and consultation outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Over the 12\u00a0months, 994 cases were submitted by 158 district clinicians across 17 hospitals (mean 3 cases\/day). Pediatric patients accounted for 47% of consultations. The most frequent presentations were acute abdomens (25%), trauma (22%), and congenital abnormalities (21%). Nearly 70% of cases included supporting images. Among the 811 consultations that required a response, 92% received specialist input, and 69% of the responses were provided within 1 h.\u00a0Most cases (69%) resulted in a recommended referral, whereas 8% were managed locally with remote specialist guidance. Other outcomes included referral at a later stage (9%), forwarding to consultants outside of the MCN (3%), and an unknown conclusion (3%). In 183 cases, a referral notification was submitted without requiring a response. The MCN also supported professional learning and triggered social service mobilization in cases of suspected violence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The Malawi Surgical MCN has evolved into a sustainable, locally owned platform supporting real\u2010time decision\u2010making, capacity building, and coordination of surgical care across district and central hospitals. Its continuation, after donor funding ended, demonstrates the feasibility of affordable, digitally enabled clinical networks in resource\u2010constrained environments. The MCN is a potentially scalable model that could be used to strengthen surgical systems and reduce inequities in access to specialist care across sub\u2010Saharan Africa and other similar contexts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/wjs.70602","type":"journal-article","created":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T13:15:37Z","timestamp":1791119737000},"source":"Crossref","is-referenced-by-count":0,"title":["From Effectiveness to Long\u2010Term Impact. Sustainability of a Frugal Managed Surgical Consultation Network in Low\u2010Income Settings: Evidence From Malawi"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0440-6051","authenticated-orcid":false,"given":"Jakub","family":"Gajewski","sequence":"first","affiliation":[{"name":"School of Population Health RCSI Institute of Global Surgery  Dublin Ireland"},{"name":"Centre for Global Surgery University of Stellenbosch  Stellenbosch South\u00a0Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaja","family":"Czwojda","sequence":"additional","affiliation":[{"name":"School of Medicine RCSI  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3465-9850","authenticated-orcid":false,"given":"Chiara","family":"Pittalis","sequence":"additional","affiliation":[{"name":"School of Population Health RCSI Institute of Global Surgery  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruairi","family":"Brugha","sequence":"additional","affiliation":[{"name":"School of Population Health RCSI  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Waluza","sequence":"additional","affiliation":[{"name":"Queen Elizabeth Central Hospital  Blantyre Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Noah","sequence":"additional","affiliation":[{"name":"Queen Elizabeth Central Hospital  Blantyre Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Borgstein","sequence":"additional","affiliation":[{"name":"Queen Elizabeth Central Hospital  Blantyre Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,4]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2589\u20107500(21)00238\u20107"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.4102\/sajhivmed.v20i1.982"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2589\u20107500(20)30027\u20103"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.3402\/gha.v7.25606"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.3389\/fdgth.2022.876957"},{"key":"e_1_2_11_7_1","volume-title":"Framework on Integrated, people\u2010centred Health Services: Report by the Secretariat. 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