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. 2022 Mar;46(3):486-496.
doi: 10.1007/s00268-021-06379-8. Epub 2021 Nov 27.

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

H A Adde  1 , A J van Duinen  2   3 , L M Sherman  4 , B C Andrews  5 , Ø Salvesen  6 , N K Dunbar  7 , A J Bleah  8 , T G Weiser  9   10   11 , H A Bolkan  2   3
Affiliations

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

H A Adde et al. World J Surg. 2022 Mar.

Abstract

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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Figures

Fig. 1
Fig. 1
Geographic distribution of the surgical workforce and surgical provider productivity
Fig. 2
Fig. 2
Density of surgical providers and proportion of people living in absolute poverty. Each data point represents one of the fifteen counties (administrative areas) in Liberia
Fig. 3
Fig. 3
Cumulative percentage of surgical providers by cadre and their operative productivity
None
Textbox: Recommendations to strengthen reporting metrics and improve the surgical system globally and locally in Liberia
See this image and copyright information in PMC

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