The pediatric surgery workforce in low- and middle-income countries: problems and priorities
Section snippets
Current state of the workforce in LMICs around the world
With high birth rates and a low life expectancy, children constitute nearly half of the population in many LMICs. This along with a lack of appropriate human resources for the surgical care of children adversely affect the number of pediatric surgeons per population (density) A recent report indicated that the number of pediatric surgeons is inversely proportional to a country’s birth rate and has a positive correlation with gross domestic product (GDP) in countries with a GDP per capita less
Reasons for the current workforce problem
The reasons for the shortage in pediatric surgical workforce in LMICs are multi-fold and complex.
These include an inadequate pipeline of trainees, limited training resources, emigration of trained providers (the so-called “brain drain” phenomenon), uneven distribution of providers within countries themselves, and the attrition or disengagement of existing providers. All of these problems reflect fundamental weaknesses in health system finances, infrastructure, and governance, which are further
Current progress being made
The global pediatric surgery community and LMICs themselves continue efforts to provide pediatric surgical care in resource-limited settings and to expand the effective capacity for provision of care. Such efforts include but are not limited to the following.
Priorities moving forward
While the next steps toward improvement of the current workforce issues must include a broad-based, multi-disciplinary approach that incorporates other critical support services, here we will primarily focus on what is necessary to increase and enhance the cadre of pediatric surgical providers in LMICs.
Conclusion
The pediatric surgical workforce is in crisis within LMICs around the world and the problem will assuredly worsen in coming years if not addressed. Furthermore, the staggering gap between the highest-income countries and resource-poor regions continues to grow. A lack of funding, training opportunities, and political will in combination with a critical lack of mentors and strong push–pull factors have limited the number of new entrants into the workforce and has contributed to the significant
Acknowledgment
We acknowledge the help of the following pediatric surgeons and anesthesiologists who helped to provide some of the information used in this report:
Dr. Mohammed Abdel-Latif, Pediatric Surgeon, Cairo, Egypt;
Dr. Ali F Al-Mayoof, Department of Pediatric Surgery, College of Medicine, Al-Mustansiriya University, Baghdad, Iraq;
Professor Tahmina Banu, Department of Pediatric Surgery, Chittagong Medical College & Hospital, Chittagong 4000 Bangladesh;
Professor Muhammad Amjad Chaudhary, President,
References (93)
- et al.
Global comparison of pediatric surgery workforce and training
J Pediatr Surg
(2015) - et al.
Challenges of training and delivery of paediatric surgical services in Africa
J Pediatr Surg
(2010) - et al.
Pediatric surgery in Nigeria
J Pediatr Surg
(2006) - et al.
“Louw” beginning….pediatric surgery in South Africa
J Pediatr Surg
(2003) - et al.
Pediatric surgical camps as one model of global surgical partnership: a way forward
J Pediatr Surg
(2014) - et al.
Pediatric emergency and essential surgical care in Zambian hospitals: a nationwide study
J Pediatr Surg
(2013) - et al.
Estimating pediatric surgical need in developing countries: a household survey in Rwanda
J Pediatr Surg
(2014) Training and delivery of pediatric surgery services in Asia
J Pediatr Surg
(2000)Pediatric surgery in Latin America
J Pediatr Surg
(2000)Disparities in pediatric surgical care in Puerto Rico: a call for action
J Pediatr Surg
(2010)