A Nationwide Enumeration of the Surgical Workforce, its Production and Disparities in Operative Productivity in Liberia

A Nationwide Enumeration of the Surgical Workforce, its Production and Disparities in Operative Productivity in Liberia

Background Any health care system that strives to deliver good health and well-being to its population relies on a trained workforce. The aim of this study was to enumerate surgical provider density, describe operative productivity and assess the association between key surgical system characteristi...

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Bibliographic Details
Published in:World journal of surgery Vol. 46; no. 3; pp. 486 - 496
Main Authors: Adde, H. A., van Duinen, A. J., Sherman, L. M., Andrews, B. C., Salvesen, Ø., Dunbar, N. K., Bleah, A. J., Weiser, T. G., Bolkan, H. A.
Format: Journal Article
Language:English
Published: Cham Springer International Publishing 01-03-2022
Springer Nature B.V
Subjects:
Abdominal Surgery
Cardiac Surgery
Data collection
Delivery of Health Care
Density
Efficiency
Enumeration
Expenditures
Family income
General Surgery
Health care
Health sciences
Hospitals
Human resources
Humans
Infrastructure
Liberia
Local anesthesia
Logbooks
Medicine
Medicine & Public Health
Physicians
Population
Productivity
Specialization
Surgery
Surgery in Low and Middle Income Countries
Surgical Procedures, Operative
Thoracic Surgery
Vascular Surgery
Workforce
Liberia
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Summary:Background Any health care system that strives to deliver good health and well-being to its population relies on a trained workforce. The aim of this study was to enumerate surgical provider density, describe operative productivity and assess the association between key surgical system characteristics and surgical provider productivity in Liberia. Methods A nationwide survey of operation theatre logbooks, available human resources and facility infrastructure was conducted in 2018. Surgical providers were counted, and their productivity was calculated based on operative numbers and full-time equivalent positions. Results A total of 286 surgical providers were counted, of whom 67 were accredited specialists. This translated into a national density of 1.6 specialist providers per 100,000 population. Non-specialist physicians performed 58.3 percent (3607 of 6188) of all operations. Overall, surgical providers performed a median of 1.0 (IQR 0.5–2.7) operation per week, and there were large disparities in operative productivity within the workforce. Most operations (5483 of 6188) were categorized as essential, and each surgical provider performed a median of 2.0 (IQR 1.0–5.0) different types of essential procedures. Surgical providers who performed 7–14 different types of essential procedures were more than eight times as productive as providers who performed 0–1 essential procedure (operative productivity ratio = 8.66, 95% CI 6.27–11.97, P  < 0.001). Conclusion The Liberian health care system struggles with an alarming combination of few surgical providers and low provider productivity. Disaggregated data can provide a high-resolution picture of local challenges that can lead to local solutions.
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ISSN:0364-2313
1432-2323
DOI:10.1007/s00268-021-06379-8