Surgical Care in Sierra Leone

Facilities

Government facilities providing surgical care in the Western Area (Freetown and surrounding districts); comprising Connaught Hospital (national tertiary care), district hospitals (Lumley and Rukupa), and Princess Christina Maternity Hospital.  

Setting

Historically, surgical care has not been prioritized in Sierra Leone when compared to other LMICs.1 Around 60 facilities provide surgical care in Sierra Leone, but only 40% of procedures are provided by government facilities.2 Surgical volume is very low, at 400 procedures per 100,000 population, less than one tenth of the expected rate; caesarean sections account for just 2.1% of births, five to seven times lower than optimal.3 Nevertheless, caesarean sections account for one fifth of all procedures. This translates into considerable unmet needs for surgical care; it was estimated in a 2012 population survey that a quarter of the population had a condition requiring a surgical consultation and a quarter of deaths were likely due to conditions requiring surgery.4 

Picture: King’s Sierra Leone Partnership

Sierra Leone has only 0.15 specialist surgeons, anaesthetists and obstetricians (SAOs) per 100,000, less than 1% of the recommended level and most procedures are performed by non-specialists, and nurse anaesthetists. Resources are maldistributed, with an urban bias, and underutilised, with very low provider productivity, particularly in the government sector.2 Alongside inefficiency, low demand for care is a problem, with concerns regarding out-of-pocket costs, trust, and low perceived quality of care.5   

References

  1. Dare AJ, Lee KC, Bleicher J, et al. Prioritizing Surgical Care on National Health Agendas: A Qualitative Case Study of Papua New Guinea, Uganda, and Sierra Leone. PLoS Med 2016;13:e1002023. doi:10.1371/journal.pmed.1002023
  2. Bolkan HA, Hagander L, von Schreeb J, et al. The Surgical Workforce and Surgical Provider Productivity in Sierra Leone: A Countrywide Inventory. World J Surg 2016;40:1344–51. doi:10.1007/s00268-016-3417-1
  3. Bolkan HA, Von Schreeb J, Samai MM, et al. Met and unmet needs for surgery in Sierra Leone: A comprehensive, retrospective, countrywide survey from all health care facilities performing operations in 2012. Surgery 2015;157:992–1001. doi:10.1016/j.surg.2014.12.028
  4. Pruitt SD, Epping-Jordan JE. Preparing the 21st century global healthcare workforce. BMJ 2005;330:637–9.
  5. Groen RS, Sriram VM, Kamara TB, et al. Individual and community perceptions of surgical care in Sierra Leone. Trop Med Int Health TM IH 2014;19:107–16. doi:10.1111/tmi.12215