The pediatric surgery workforce in low- and middle-income countries: problems and priorities

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Abstract

Most of the world is in a surgical workforce crisis. While a lack of human resources is only one component of the myriad issues affecting surgical care in resource-poor regions, it is arguably the most consequential. This article examines the current state of the pediatric surgical workforce in low- and middle-income countries (LMICs) and the reasons for the current shortfalls. We also note progress that has been made in capacity building and discuss priorities going forward. The existing literature on this subject has naturally focused on regions with the greatest workforce needs, particularly sub-Saharan Africa (SSA). However, wherever possible we have included workforce data and related literature from LMICs worldwide. The pediatric surgeon is of course critically dependent on multi-disciplinary teams. Surgeons in high-income countries (HICs) often take for granted the ready availability of excellent anesthesia providers, surgically trained nurses, radiologists, pathologists, and neonatologists among many others. While the need exists to examine all of these disciplines and their contribution to the delivery of surgical services for children in LMICs, for the purposes of this review, we will focus primarily on the role of the pediatric surgeon.

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,

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