title: The Surgical Workforce and Surgical Provider Productivity in Sierra Leone: A Countrywide Inventory.
abstract: Limited data exist on surgical providers and their scope of practice in low-income countries (LICs). The aim of this study was to assess the distribution and productivity of all surgical providers in an LIC, and to evaluate correlations between the surgical workforce availability, productivity, rates, and volume of surgery at the district and hospital levels.
  
  
  
  Data on surgeries and surgical providers from 56 (93.3 %) out of 60 healthcare facilities providing surgery in Sierra Leone in 2012 were retrieved between January and May 2013 from operation theater logbooks and through interviews with key informants.
  
  
  
  The Sierra Leonean surgical workforce consisted of 164 full-time positions, equal to 2.7 surgical providers/100,000 inhabitants. Non-specialists performed 52.8 % of all surgeries. In rural areas, the densities of specialists and physicians were 26.8 and 6.3 times lower, respectively, compared with urban areas. The average individual productivity was 2.8 surgeries per week, and varied considerably between the cadres of surgical providers and locations. When excluding four centers that only performed ophthalmic surgery, there was a positive correlation between a facility's volume of surgery and the productivity of its surgical providers (r s = 0.642, p < 0.001).
  
  
  
  Less than half of all of the surgery in Sierra Leone is performed by specialists. Surgical providers were significantly more productive in healthcare facilities with higher volumes of surgery. If all surgical providers were as productive as specialists in the private non-profit sector (5.1 procedures/week), the national volume of surgery would increase by 85 %.
authors.affiliation: Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Box 8905, 7491, Trondheim, Norway. hakon.a.bolkan@ntnu.no.
authors.forename: Håkon A
authors.identifier: 0000-0002-9609-4093
authors.initials: HA
authors.lastname: Bolkan
authors.affiliation: Paediatric Surgery and Global Paediatrics, Department of Paediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Hagander
authors.affiliation: Health System and Policy Research Group, Karolinska Institutet, 171 77, Stockholm, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: von Schreeb
authors.affiliation: Ministry of Health and Sanitation, Freetown, Sierra Leone.
authors.forename: Donald
authors.initials: D
authors.lastname: Bash-Taqi
authors.affiliation: Department of Surgery, Connaught Hospital and College of Medicine Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
authors.forename: Thaim B
authors.initials: TB
authors.lastname: Kamara
authors.affiliation: Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Box 8905, 7491, Trondheim, Norway.
authors.forename: Øyvind
authors.initials: Ø
authors.lastname: Salvesen
authors.affiliation: Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Box 8905, 7491, Trondheim, Norway.
authors.forename: Arne
authors.initials: A
authors.lastname: Wibe
mesh_terms: D003906:Developing Countries / Q000706:statistics & numerical data*; D004526:Efficiency; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D009726:Nurses / Q000706:statistics & numerical data / Q000600:supply & distribution; D019035:Rural Health Services; D012807:Sierra Leone; D013038:Specialization / Q000706:statistics & numerical data*; D066231:Surgeons / Q000706:statistics & numerical data* / Q000600:supply & distribution*; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D019037:Urban Health Services; D000078329:Workforce
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