The challenges of surgical provision in Africa

A multitude of different factors affect the access for patients to get a surgical service in the vast territory of Sub-Saharan Africa and the many different countries. These include insufficient healthcare workers, poor infrastructure, lack of suitable equipment and supplies, and poverty among the population needing surgery. A study reporting on the people and facilities for Uganda identified that there was a total of 107 general surgeons, 97 specialty surgeons, 124 obstetricians/gynaecologists (OB/GYNs), and 17 anaesthesiologists in Uganda, for a rate of one surgeon per 100,000 people. There were 0.2 major operating theatres per 100,000 people.

Altogether, 53% of all operations were general surgery cases, and 44% were OB/GYN cases. In all, 73% of all operations were performed on an emergency basis. All hospitals reported unreliable supplies of water and electricity. Essential equipment was missing across all hospitals, with no pulse oximeters found at any facilities.¹ In 2005, slightly over one quarter of a million women in Africa died from complications of childbirth: most of these deaths could have been avoided by providing women with access to basic obstetric and obstetric surgical care.²

How does the situation described affect potential patients? We understand that there is an increasing need for surgery due to more trauma, a greater reliance on Caesarean section deliveries, people living longer and therefore more likely to suffer the diseases of older age, and a greater prevalence of cancer, which needs surgical intervention. Surgical disease is thought to account for a substantial proportion of the global burden of disease; some estimates have suggested 11% of the global need for healthcare.³