World Journal of Surgery

, Volume 36, Issue 2, pp 232–239 | Cite as

Development of a Surgical Capacity Index: Opportunities for Assessment and Improvement

  • Steve KwonEmail author
  • T. Peter Kingham
  • Thaim B. Kamara
  • Lawrence Sherman
  • Eileen Natuzzi
  • Charles Mock
  • Adam Kushner



Significant gaps exist in the provision of surgical care in low- and middle-income countries (LMICs). The purpose of this study was to develop a metric to monitor surgical capacity in LMICs.


The World Health Organization developed a survey called the Tool for Situational Analysis to Assess Emergency and Essential Surgical Care. Using this tool, we developed a surgical capacity scoring index and assessed its usefulness with data from Sierra Leone, Liberia, and the Solomon Islands.


There were data from 10 hospitals in Sierra Leone, 16 hospitals in Liberia, and 9 hospitals in the Solomon Islands. The levels of surgical capacity were created using our scoring index based on a possible 100 points: level 1 for hospitals with <50 points, level 2 with 50–70 points, level 3 with 70–80 points, and level 4 with >80 points. In Sierra Leone, 44% of the hospitals had a surgical capacity rating of level 1, 50% level 2, and 10% level 3. In Liberia, 37.5% of the hospitals had a surgical capacity rating of level 1, 56.3% level 2, and only one hospital level 3. For Sierra Leone and Liberia, two factors—infrastructure and personnel—had the greatest deficits. In the Solomon Islands, 44.4% of the hospitals had their surgical capacity rated at level 1, 22.2% at level 2, 11.1% at level 3, and 22.2% at level 4.


Pending pilot testing for reliability and validity, it appears that a systematic hospital surgical capacity index can identify areas for improvement and provide an objective measure for monitoring changes over time.


Surgical Care Solomon Island Surgical Capacity Effective Coverage Procedural Volume 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Conflict of interest

There is no financial or personal conflict of interest by any of the authors.


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Copyright information

© Société Internationale de Chirurgie 2011

Authors and Affiliations

  • Steve Kwon
    • 1
    Email author
  • T. Peter Kingham
    • 2
    • 3
  • Thaim B. Kamara
    • 4
  • Lawrence Sherman
    • 5
  • Eileen Natuzzi
    • 7
  • Charles Mock
    • 1
  • Adam Kushner
    • 3
    • 6
  1. 1.Department of SurgeryUniversity of WashingtonSeattleUSA
  2. 2.Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  3. 3.Surgeons OverSeas (SOS)New YorkUSA
  4. 4.Department of SurgeryConnaught HospitalFreetownSierra Leone
  5. 5.Department of SurgeryFirestone HospitalMonroviaLiberia
  6. 6.Department of SurgeryColumbia UniversityNew YorkUSA
  7. 7.Department of SurgeryScripps Memorial HospitalEncinitasUSA

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