World Journal of Surgery

, Volume 36, Issue 5, pp 1056–1065 | Cite as

Challenges of Surgery in Developing Countries: A Survey of Surgical and Anesthesia Capacity in Uganda’s Public Hospitals

  • Allison F. Linden
  • Francis Serufusa Sekidde
  • Moses Galukande
  • Lisa Marie Knowlton
  • Smita Chackungal
  • K. A. Kelly McQueen



There are large disparities in access to surgical services due to a multitude of factors, including insufficient health human resources, infrastructure, medicines, equipment, financing, logistics, and information reporting. This study aimed to assess these important factors in Uganda’s government hospitals as part of a larger study examining surgical and anesthesia capacity in low-income countries in Africa.


A standardized survey tool was administered via interviews with Ministry of Health officials and key health practitioners at 14 public government hospitals throughout the country. Descriptive statistics were used to analyze the data.


There were a total of 107 general surgeons, 97 specialty surgeons, 124 obstetricians/gynecologists (OB/GYNs), and 17 anesthesiologists in Uganda, for a rate of one surgeon per 100,000 people. There was 0.2 major operating theater per 100,000 people. Altogether, 53% of all operations were general surgery cases, and 44% were OB/GYN cases. In all, 73% of all operations were performed on an emergency basis. All hospitals reported unreliable supplies of water and electricity. Essential equipment was missing across all hospitals, with no pulse oximeters found at any facilities. A uniform reporting mechanism for outcomes did not exist.


There is a lack of vital human resources and infrastructure to provide adequate, safe surgery at many of the government hospitals in Uganda. A large number of surgical procedures are undertaken despite these austere conditions. Many areas that need policy development and international collaboration are evident. Surgical services need to become a greater priority in health care provision in Uganda as they could promise a significant reduction in morbidity and mortality.


National Health Insurance Scheme Nursing Assistant Clinical Officer Catchment Population Major Procedure 
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.



We thank all of the Ugandan Ministry of Health officials, hospital directors, clinical officers, nurses, operating theater assistants, and laboratory technicians without whose help and enthusiasm this study would not have been possible.

Conflict of interest

The authors declare that there was no grant support or conflicts of interest.


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Copyright information

© Société Internationale de Chirurgie 2012

Authors and Affiliations

  • Allison F. Linden
    • 1
    • 2
    • 8
  • Francis Serufusa Sekidde
    • 3
  • Moses Galukande
    • 4
  • Lisa Marie Knowlton
    • 5
  • Smita Chackungal
    • 6
  • K. A. Kelly McQueen
    • 3
    • 7
  1. 1.Department of Global Health and Social Medicine, Program in Global Surgery and Social ChangeHarvard Medical SchoolBostonUSA
  2. 2.Department of SurgeryGeorgetown University HospitalWashingtonUSA
  3. 3.Harvard Humanitarian InitiativeBostonUSA
  4. 4.Department of Surgery, School of Medicine, College of Health SciencesMakerere UniversityKampalaUganda
  5. 5.Department of SurgeryUniversity of British ColumbiaVancouverCanada
  6. 6.Department of SurgeryThe University of Western OntarioLondonCanada
  7. 7.Valley Anesthesiology Consultants, LtdPhoenixUSA
  8. 8.BostonUSA

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