The Scale‐Up of the Global Surgical Workforce: Can Estimates be Achieved by 2030?

Abstract

Background The Lancet Commission on Global Surgery showed that countries with surgeon, anesthetist, and obstetrician (SAO) densities of 20–40 SAO/100,000 population were associated with improved health outcomes and recommended a global surgical workforce scale‐up by 2030. Whether countries would be able to achieve such scale‐up efforts in that time‐frame is unknown. Methods A differential equation model was used to estimate the growth rate and number of SAO necessary for each country to reach the aforementioned SAO densities. Workforce data from Mexico and India were used to estimate achievable rates of SAO scale‐up for middle‐ and low‐income countries, respectively. Secular surgical growth rates were estimated to demonstrate what might occur without dedicated scale‐up efforts. Results To reach at least 20 SAO/100,000 population in all countries by 2030, over 808 thousand SAO need to be trained by 2030. To reach at least 40 SAO/100,000 population, over 2.1 million SAO need to be trained. If countries adopt a scale‐up rate similar to Mexico's previously achieved rate of scale‐up, 66% of countries would have 20 SAO/100,000 population by 2030. If countries adopt a scale‐up rate similar to India's previously achieved rate of scale‐up, 56% would have 20 SAO/100,000 population by 2030. Conclusion With dedicated efforts in surgical workforce scale‐up, significant gains in SAO density can be made worldwide. However, without intervention, many countries are unlikely to improve their current workforce densities. Investments in workforce scale‐up are likely to yield workforce gains that mirror current resource states.

Exploring the Impact of COVID‐19 on Progress Towards Achieving Global Surgery Goals

“…HCW welfare has a direct bearing on surgical service provision, in one hospital in Sierra Leone during the Ebola outbreak, surgical volumes plummeted to 3% of baseline accompanied by the death of 25% of the surgical workforce [20]. Many countries are unlikely to reach the SOA workforce goals set by the LCoGS by 2030, without deliberate intervention; however, ongoing losses from the ‘brain‐drain’ as well as the impact of COVID‐19 will worsen the situation [21]. Models that rely on appealing to a sense of duty have consistently failed to improve HCW motivation [22].…”

Assessment of Surgical Care Provided in National Health Services Hospitals in Mozambique: The Importance of Subnational Metrics in Global Surgery

“…Stratification by province shows more than a tenfold difference in case volume density between the capital city Maputo and rural areas (i.e., Zambezia, Niassa). This ‘tale of two metrics’ between rural and urban settings is not unique [10, 33]. A study in Mozambique, Tanzania, and Uganda found low rates of major surgeries at district hospitals, ranging from 50 to 450 surgical procedures per 100,000 people, and that the majority of non‐obstetric surgery is for emergencies rather than for elective conditions, suggesting that district residents do not receive surgical care for common (non‐emergent) surgical conditions in local hospitals [34].…”

Achieving Surgical, Obstetric, Trauma, and Anesthesia (SOTA) care for all in South Asia

“…The scale-up should happen at an adequate rate/level in a target-oriented manner. For instance, to achieve the target density of 20 SAO specialists per 100,000 population by 2030, Bangladesh, India, and Pakistan would need 40,288, 291,824, and 47,710 more SAO specialists compared to 2015 ( 140 ). Additionally, the training spots should be equitably distributed ( 141 ).…”