Surgical Human Resources According to Types of Health Care Facility: An Assessment in Low- and Middle-Income Countries

• Published in: World journal of surgery Vol. 41; no. 11; pp. 2667 - 2673
• Main Authors: Sheik Ali, Shirwa, Jaffry, Zahra, Cherian, Meena N., Kunjumen, Teena, Nkwowane, Annette M., Leather, Andrew J. M., Von Muhlenbrock, Hernan Montenegro, Kelley, Edward, Campbell, James
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.11.2017; Springer Nature B.V
• Subjects: Abdominal Surgery; Anesthesia; Anesthesiologists - supply & distribution; Anesthesiology; Cardiac Surgery; Community Health Centers; Cross-Sectional Studies; Developing Countries; Economic models; General Surgery; Health care; Health care facilities; Health Facilities; Hospital facilities; Hospitals; Hospitals, Community; Hospitals, Private; Human resources; Humans; Income; Institutions; Low income groups; Medical personnel; Medicine; Medicine & Public Health; Original Scientific Report; Personnel; Physicians; Secondary analysis; Surgeons; Surgeons - supply & distribution; Surgery; Surgical instruments; Thoracic Surgery; Vascular Surgery; Workforce
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-017-4078-4

Background A robust health care system providing safe surgical care to a population can only be achieved in conjunction with access to competent surgical personnel. It has been reported that 5 billion people do not have access to safe, affordable surgical and anaesthesia care when needed. This study aims to fill the existing gap in evidence by quantifying shortfalls in trained personnel delivering safe surgical and anaesthetic care in low- and middle-income countries (LMICs) according to the type of health care facility. Methods We conducted secondary analysis of 1323 health facilities, in 35 low- and middle-income countries using facility-based cross-sectional data from the World Health Organization Situational Analysis Tool to Assess Emergency and Essential Surgical Care. Results The majority of surgical and anaesthetic care in LMICs was provided by general doctors (range 13.8–41.1%; mean 27.1%). Non-physicians made up a significant proportion of the surgical workforce in LMICs. 26.76% of the surgical and anaesthetic workforce was provided by clinical medical officers and nurses. Private/NGO/mission hospitals, large, well-resourced institutions had the highest proportion of surgeons compared to any other type of health care facility at 27.92%. This compares to figures of 18.2 and 19.96% of surgeons at health centres and subdistrict/community hospitals, respectively, representing the lowest level of health facility. Conclusions We highlight the significant proportion of non-physicians delivering surgical and anaesthetic care in LMICs and illustrate wide variations according to the type of health care facility.