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. 2025 May 27;25(1):760.
doi: 10.1186/s12913-025-12892-6.

Assessment of surgical capacity and productivity in high-volume Ethiopian hospitals: mixed method study

Amare Hailekiros Gebregzi  1 , Elubabor Buno Teko  2 , Abiy Dawit Tantu  3 , Natinael Tesfaye Jale  3 , Genanaw Kassie Getahun  4 , Yohannes Molla Asemu  5
Affiliations

Assessment of surgical capacity and productivity in high-volume Ethiopian hospitals: mixed method study

Amare Hailekiros Gebregzi et al. BMC Health Serv Res. .

Abstract

Background: In Ethiopia and other low-and middle-income countries, access to emergency and elective surgical care is still inadequate and inequitable. Ethiopia has initiated a nationwide strategic plan aimed at tackling obstacles within the surgical system. The aim of this study was to assess surgical and anesthesia care capacity and productivity in high volume Ethiopian hospitals.

Methods: An explanatory mixed-methods study was conducted in 24 high-volume public hospitals across Ethiopia's 10 regions and 2 city administrations. Data were collected through structured document reviews, site observations, and interviews using a validated WHO-aligned tool. Quantitative data were analyzed using SPSS, and qualitative responses were thematically analyzed using ATLAS.ti.

Results: Addis Ababa hosts over 60% of the national surgical workforce, highlighting stark regional disparities. While 80% of hospitals reported adequate infrastructure, site observations revealed functional inconsistencies in PACU design, sterilization units, and equipment availability. Only 77% of hospitals consistently implemented patient monitoring and handover protocols. Surgical productivity was low, with an average of 2.5 surgeries per week per clinician and 52.39% annual workforce productivity. Best practices included the use of EMRs, backlog-reduction campaigns, and daily interdisciplinary briefings. However, persistent challenges included inadequate staffing, poor infrastructure, and uneven adoption of safety protocols.

Conclusion and recommendation: Ethiopia's surgical system shows promising innovations in select hospitals, yet national scale-up is hindered by infrastructure gaps, uneven workforce distribution, and inconsistent safety practices. Addressing these challenges requires data-driven planning, targeted investment in underserved regions, and expanded use of digital systems and collaborative networks to promote best practice adoption across facilities.

Keywords: Ethiopia; Infrastructure; Productivity; Surgical and anesthesia workforce.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethical approval for this study was obtained from the Ethiopian Association of Anesthetists Institutional Research Ethics Review Committee (Protocol number: /0895/007/2016). Informed consent was obtained from all participants prior to their participation. The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki.16/3 Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Surgical workforce in the Addis Ababa city administration, January 2024. (IEOS -Integrated Emergency Surgical Officer)
Fig. 2
Fig. 2
Regional surgical workforce disparity, January 2024. (IEOS -Integrated Emergency Surgical Officer)
Fig. 3
Fig. 3
Number of functional OR tables, January 2024. ZMH - Zewditu memorial hospital, WSUCSH – Woliyta Sodo University Comprehensive Specialized Hospital
Fig. 4
Fig. 4
Key patient monitoring and anesthesia care protocols availability and utilization, January 2024
Fig. 5
Fig. 5
3.4. Compliance with Post Anesthesia Care Unit (PACU) Standards, January 2024. BLS - Basic Life Support, ALS - Advanced Life Support
Fig. 6
Fig. 6
Design and features of PACU, January 2024
Fig. 7
Fig. 7
PACU standard compliance per bed, January 2024
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