• Strengthen Pillar — Workshop Survey

    Share your votes on six governance proposals and help refine the SPINE20 assessment in under 15 minutes.

  • Please Submit before September 15th

  • A Discussion Paper of the Strengthen Pillar
    Prepared for the SPINE20 New York Strategic Summit — September 2026

    This survey has two short parts. Part One asks you to record your view on six governance proposals. Part Two asks you to help us sharpen our assessment of SPINE20 as an organization, which we will work through together at the Summit.

    Why it matters — and it only takes 15 minutes
    These proposals will shape SPINE20's governance, leadership and accountability for years to come. Every recorded vote — including a qualified "yes, but" — helps the Executive Board understand how much support each proposal genuinely has. Part Two then ensures the live session in New York starts from where the disagreement actually is.
  • Date*
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    2 digit month, 2 digit day, 4 digit year

  • Part One — Six Governance Proposals

  • Each proposal below is a building block that any future structure would need. Please register a vote on each.

    Note: these are the components of a governance structure. At the Summit, the Strengthen session will present three different ways of assembling them, and the choice between those options remains genuinely open for the room to make.

  • Question 1 — Adopting a Minimum Viable Governance Model

  • SPINE20 currently operates without clearly defined roles, decision-making authority or continuity between summits. The proposal is to adopt a Minimum Viable Governance model that can be put into operation immediately: defined officer roles, clear decision-making authority, rules on representation and quorum, and a six-month review cycle. This is intended to give SPINE20 a working structure without waiting for full legal formalization.
  • Do you support adopting a Minimum Viable Governance model as SPINE20's immediate operating structure?*

  • Question 2 — Defined Core Officers on a Three-Year Cycle

  • The proposal is to establish three core officer roles — President, Secretary General and Treasurer — each serving a three-year cycle of elect, active and past. The three tracks would be staggered so that only one office turns over in any given year, ensuring that institutional memory is never lost across all three at once.
  • Do you support establishing defined core officers on a staggered three-year cycle?*

  • Question 3 — Regional Representation

  • SPINE20 currently has strong representation in some regions and little or none in others, with light coverage in parts of Africa and no representation in Oceania. The proposal is to appoint regional officers covering all six regions — Asia, Africa, Europe, North America, South America and Oceania — so that SPINE20 has genuinely global reach.
  • Do you support appointing regional officers to ensure global representation?*

  • Question 4 — An Impact Reporting Framework and Baseline Audit

  • After six summits, SPINE20 cannot yet clearly demonstrate what changed as a result of its recommendations. The proposal is to establish an impact-reporting framework, beginning with a baseline audit of all six previous summits, followed by a published Annual Impact Report and a risk register monitored by the Executive Committee.
  • Do you support establishing an impact-reporting framework, including a six-summit baseline audit and an Annual Impact Report?*

  • Question 5 — A Transitional Structure Before the Full Model

  • A full governance structure may exceed what SPINE20 can currently fund or staff. The proposal is therefore to begin with a deliberately minimal transitional structure for 2026–2027 — core officers, a small executive and continuity for the host handover — with the fuller model phased in only as capacity and funding allow.
  • Do you support beginning with a minimal transitional structure, with the full model phased in over time?*

  • Question 6 — Pathway from Summit Direction to Formal Adoption

  • A summit cannot itself amend the Memorandum of Understanding, which is governed by Swiss law and can be changed only by a writing executed by the Founding Partner Societies. The proposal is that the Summit provides strategic direction, which the Executive Committee then adopts by resolution, with an Amendment No. 2 executed by the Founding Partner Societies to give the new structure legal force.
  • Do you support this pathway — Summit direction, Executive Committee resolution, then a signed Amendment No. 2?*

  • Part Two — Our Assessment of SPINE20

  • STRENGTHS
    • A committed international network and experienced past leadership.
    • A formal founding instrument (the MoU and Amendment No. 1), governed by Swiss law.
    • Six years of consensus recommendations and genuine academic credibility.
    • Demonstrated local policy impact, including advocacy that has helped move spine-related rehabilitation onto a national government agenda.
    • A pre-agreed blueprint for a legal entity already contained in Exhibit B of the MoU.
    WEAKNESSES
    • No legal entity — cannot hold an office, hire staff, receive grants or fundraise directly.
    • No sustainable finance model; most past meetings have needed bailing out.
    • Governance is informal; accountability, succession and continuity between summits are weak.
    • Ownership collapses once a host country finishes its summit.
    • Heavy dependence on the annual G20 host cycle, which SPINE20 cannot influence, with risk of volunteer burnout.
    • Annual-meeting format is fragile and costly; some hosts cannot fully fund it.
    • Thin sustained scientific output between summits; no systematic measurement of past impact.
    • No defined primary audience for our outputs.
    • No patient voice; limited engagement with policymakers.
    • Regional gaps — light coverage in parts of Africa, none in Oceania.
    OPPORTUNITIES
    • The New York Summit as a moment to set direction on a concrete model.
    • Exhibit B and Article 6.d provide a ready-made pathway to legal status.
    • A transitional bridging model could stabilise finance while an entity is built.
    • Regional officers could close the Africa and Oceania gaps.
    • Aligning summits with a host society's annual meeting could cut cost and lift engagement.
    • Industry-sponsorship and advocacy partnerships (for example with the WHO).
    THREATS
    • Being seen as an insular academic forum without demonstrable policy impact.
    • Without sustainable finance, future meetings may not be deliverable.
    • Volunteer burnout and lost momentum if the annual cycle repeats without reform.
    • Legal uncertainty following a founding partner's withdrawal, if left unaddressed.
    • Rotating among only a few well-resourced hosts could exclude emerging voices.
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  • Question 10 — Which THREE organizational challenges matter most?*
  • Please select exactly THREE.
  • Thank you. Part One results will be presented to the Executive Board; Part Two will be consolidated and shared at the Strengthen session in New York.
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