South African surgeons Dr Tim Forgan and Dr Imraan Mia use a robot called DaVinci to perform delicate operations at the Tygerberg hospital in Cape Town, South Africa, July 15, 2022. Reuters/Shelley Christians
By The East African
Africa will still need some six million surgeons to perform life-saving operations by 2030, a sign of the policy changes needed to invest in the training of medical professionals on the continent.
Yet Africa is also facing a massive brain drain as a result of its inability to absorb available health workers. This paradox was the subject of discussion at a two-day pan-African surgical conference in Kigali last week.
Data shared by health experts showed that most countries on the continent have an average of just 0.5 surgeons and 0.1 anaesthetists per 100,000 people.
And countries like Rwanda currently have 162 surgeons, well below the required standard of 1,400, and only 0.9 operating theatres per 100,000 people, leaving many without much-needed access to life-saving surgical care.
The World Health Organisation (WHO) recommends a doctor-patient ratio of 1:1,000. It doesn’t recommend a specific ratio of specialists to patients, instead urging local policymakers to adapt to needs.
“We have been experiencing scarcity in almost everything, especially hospital infrastructure, equipment, and digital facilitation, shortage of surgeons and related support professionals, most of the time, we rely on donations,” said Prof Florent Rutagarama, paediatrician and paediatric endocrinologist, Dean of the School of Medicine and Pharmacy at Vanderbilt University in the US.“Brain drain is another big problem.
”Prof Rutagarama said it was becoming increasingly difficult to retain trained surgeons and other specialist doctors, with many leaving for better opportunities abroad after training with local resources, leading to a severe shortage of professionals to build strong local health systems.
“Whenever donations are available, there is no maintenance skill, so you remain focused on your own problems and are limited in engagement.”It takes about six years to train a specialist on the continent. Surgeons need three more years to complete at a cost of about $30,000.
Prof Rutagarama added that political and economic instability exacerbates existing challenges, particularly in war-torn regions where funds are diverted to conflict rather than healthcare.
Yet, the concentration of healthcare infrastructure in capital cities has left remote areas underserved due to accessibility issues.
In Kenya, for instance, patients from marginalised counties like Turkana in the northwest often have to travel hundreds of kilometres to reach the nearest referral hospital.
The lack of specialist surgeons in these areas makes reconstructive surgery almost impossible for many.
Many of Africa’s middle class, politicians and wealthy families have increasingly been taking their patients abroad, mostly to India.
India earns an estimated $3 billion per year from African medical tourism, and this figure is expected to rise significantly as more patients from the continent seek affordable healthcare in India.
These trips trap families in a vicious cycle of intergenerational poverty, as they have to sell all their possessions to send their relatives abroad for treatment.
Mortality ratesMedical professionals in Kigali stressed the need for a 360-degree investment in surgical care, to, for instance, minimise the high post-operative mortality rates. It is estimated that 4.2 million people die within 30 days of surgery.
And why is it happening?“It’s because the nursing link is still missing,” said Dr Glory Msibi, President of the East, Central, and Southern Africa College of Nursing and Midwives.
Prof Faustin Ntirenganya, President of the Rwanda Surgical Society, said surgery accounts for about 30 percent of the global disease burden. However, for many years, the global health agenda has focused on individual diseases, resulting in surgical care receiving the least attention.
Rwanda has adopted a new strategy, dubbed 4×4, aimed at increasing both the quantity and quality of healthcare professionals, including surgeons, over the next four years to meet the WHO recommendation of at least four healthcare professionals per 1,000 people.
The ambitious plan aims to increase the health workforce by 32,973 employees by 2028.
Sub-Saharan Africa bears the weight of an acute surgical care crisis, with 93 percent of the population unable to access the reconstructive procedures they desperately need.
In a region where burns, congenital deformities and trauma-related injuries are common, the shortage of skilled surgeons and medical infrastructure compounds the suffering, leaving a vast majority without hope of healing.