World Journal of Surgery

, Volume 36, Issue 12, pp 2811–2818 | Cite as

A Survey of Surgical Capacity in Rural Southern Nigeria: Opportunities for Change

  • Jaymie A. HenryEmail author
  • Olubayo Windapo
  • Adam L. Kushner
  • Reinou S. Groen
  • Benedict C. Nwomeh



Despite growing recognition of the massive surgical burden of disease, unmet need, and disparities in access to care in many African countries, little is known about their capacity to deliver surgical, obstetric, emergency, and anesthetic care, particularly in the rural areas where up to 50 % of the population lives. This study aimed to quantify the surgical capacity of select healthcare facilities in rural southern Nigeria in five key areas: Workforce, Infrastructure, Skill, Equipment, and Supplies.


We assessed the surgical capacity of 41 private, rural hospitals in southern Nigeria using the Personnel, Infrastructure, Procedures, Equipment, and Supplies survey tool developed by Surgeons OverSeas. The survey was administered to surgical practitioners during their annual conference in November 2011.


Among the 41 hospitals surveyed, general practitioners (52.1 %) constituted most of the surgical workforce. Only one anesthesiologist was available in 16 secondary hospitals. Although most of the primary and secondary hospitals had running water (82.3 %), a designated emergency room (80.5 %), and medical records (95.9 %), only 50.3 % of all hospitals had electricity through the power grid. Also, only 37.5 % of all facilities had a blood bank and 43.8 % had an X-ray machine. Common surgical procedures were done by most of the facilities; however, cricothyroidotomy, clubfoot repair, and obstetric fistula repair were scarcely done. Less than half of the facilities provided general anesthesia, only 20 % have an anesthesia machine, and 44.5 % have a pulse oximeter.


Severe shortages in key areas should motivate stakeholders to devote more effort and resources to strengthening surgical capacity in rural southern Nigeria.


Clubfoot Rural Hospital Imperforate Anus Obstetric Fistula Ponseti Method 
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





  1. 1.
    The Lancet (eds) (2012) Global surgery–the final frontier? Lancet 379(9812):194Google Scholar
  2. 2.
    Groen RS, Samai M, Petroze RT, Kamara TB, Yambasu SE, Calland JF, Peter Kingham T, Guterbock TM, Choo B, Kushner AL (2012) Pilot testing of a population-based surgical survey tool in Sierra Leone. World J Surg 36(4):771. doi: 10.1007/s00268-012-1448-9 PubMedCrossRefGoogle Scholar
  3. 3.
    Weiser TG, Regenbogen SE, Thompson KD, Haynes AB, Lipsitz SR, Berry WR, Gawande AA (2008) An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet 372(9633):139–144PubMedCrossRefGoogle Scholar
  4. 4.
    Farmer PE, Kim JY (2008) Surgery and global health: a view from beyond the OR. World J Surg 32(4):533. doi: 10.1007/s00268-008-9525-9 PubMedCrossRefGoogle Scholar
  5. 5.
    Reshamwalla S, Gobeze AA, Ghosh S, Grimes C, Lavy C (2012) Snapshot of surgical activity in rural ethiopia: is enough being done? World J Surg 36(5):1049. doi: 10.1007/s00268-012-1511-6 PubMedCrossRefGoogle Scholar
  6. 6.
    Iddriss A, Shivute N, Bickler S, Cole-Ceesay R, Jargo B, Abdullah F, Cherian M (2011) Emergency, anaesthetic and essential surgical capacity in the Gambia. Bull World Health Organ 89(8):565–572PubMedCrossRefGoogle Scholar
  7. 7.
    Kushner AL, Cherian MN, Noel L, Spiegel DA, Groth S, Etienne C (2010) Addressing the Millennium Development Goals from a surgical perspective: essential surgery and anesthesia in 8 low- and middle-income countries. Arch Surg 145(2):154–159PubMedCrossRefGoogle Scholar
  8. 8.
    Abdullah F, Choo S, Hesse AA, Abantanga F, Sory E, Osen H, Ng J, McCord CW, Cherian M, Fleischer-Djoleto C, Perry H (2011) Assessment of surgical and obstetrical care at 10 district hospitals in Ghana using on-site interviews. J Surg Res 171(2):461–466PubMedCrossRefGoogle Scholar
  9. 9.
    Choo S, Perry H, Hesse AA, Abantanga F, Sory E, Osen H, Fleischer-Djoleto C, Moresky R, McCord CW, Cherian M, Abdullah F (2010) Assessment of capacity for surgery, obstetrics and anaesthesia in 17 Ghanaian hospitals using a WHO assessment tool. Trop Med Int Health 15:1109–1115PubMedGoogle Scholar
  10. 10.
    Sherman L, Clement PT, Cherian MN, Ndayimirije N, Noel L, Dahn B, Gwenigale WT, Kushner AL (2011) Implementing Liberia’s poverty reduction strategy: an assessment of emergency and essential surgical care. Arch Surg 146(1):35–39PubMedCrossRefGoogle Scholar
  11. 11.
    Lavy C, Tindall A, Steinlechner C, Mkandawire N, Chimangeni S (2007) Surgery in Malawi—a national survey of activity in rural and urban hospitals. Ann R Coll Surg Engl 89(7):722–724PubMedCrossRefGoogle Scholar
  12. 12.
    Kingham TP, Kamara TB, Cherian MN, Gosselin RA, Simkins M, Meissner C, Foray-Rahall L, Daoh KS, Kabia SA, Kushner AL (2009) Quantifying surgical capacity in Sierra Leone: a guide for improving surgical care. Arch Surg 144(2):122–127 discussion 128PubMedCrossRefGoogle Scholar
  13. 13.
    Notrica MR, Evans FM, Knowlton LM, Kelly McQueen KA (2011) Rwandan surgical and anesthesia infrastructure: a survey of district hospitals. World J Surg 35(8):1770. doi: 10.1007/s00268-011-1125-4 PubMedCrossRefGoogle Scholar
  14. 14.
    Petroze RT, Nzayisenga A, Rusanganwa V, Ntakiyiruta G, Calland JF (2012) Comprehensive national analysis of emergency and essential surgical capacity in Rwanda. Br J Surg 99(3):436–443PubMedCrossRefGoogle Scholar
  15. 15.
    Penoyar T, Cohen H, Kibatala P, Magoda A, Saguti G, Noel L, Groth S, Mwakyusa DH, Cherian M (2012) Emergency and surgery services of primary hospitals in the United Republic of Tanzania. BMJ Open 2(1):e000369PubMedCrossRefGoogle Scholar
  16. 16.
    Linden AF, Sekidde FS, Galukande M, Knowlton LM, Chackungal S, McQueen KA (2012) Challenges of surgery in developing countries: a survey of surgical and anesthesia capacity in Uganda’s public hospitals. World J Surg 36:1056. doi: 10.1378/chest.08-0725 PubMedCrossRefGoogle Scholar
  17. 17.
    The World Factbook (2009) Washington, DC (updated July 2012). Available at Accessed March 17, 2012
  18. 18.
    World Bank List of Economies, 2011. Available at Accessed March 17, 2012Google Scholar
  19. 19.
    Human Development Index (HDI) value (2012) Available at Accessed March 17, 2012
  20. 20.
    Ademiluyi IA, Aluko-Arowolo SO (2009) Infrastructural distribution of healthcare services in Nigeria: an overview. J Geogr Regional Planning 2(5):104–110Google Scholar
  21. 21.
    Anekwe M (2003) Brain Drain: The Nigerian experience. Available at Accessed March 18, 2012
  22. 22.
    Adenuga T (ed) (2008) The rural surgical practitioner: agent of community and social change. Safe and quality rural surgery, Layo Model Hospital. Nigeria: Association of Rural Surgical Practitioners of Nigeria (ARSPON)Google Scholar
  23. 23.
    Ajayi OO, Adebamowo CA (1999) Surgery in Nigeria. Arch Surg 134(2):206–211PubMedCrossRefGoogle Scholar
  24. 24.
    Tijani R (2011) Training for rural surgery. Eruwa, Nigeria: Association of Rural Surgical Practitioners of Nigeria (ARSPON) Secretariat, p 6Google Scholar
  25. 25.
    Oladele AO, Olabanji JK (2010) Burns in Nigeria: a review. Ann Burns Fire Disasters 23(3):120–127PubMedGoogle Scholar
  26. 26.
    World Health Organization, Global Burden of Disease. Geneva: WHO, 2002. Available at…2002/en/index.html. Accessed March 28, 2012
  27. 27.
    WHO (2002) The injury chart book: a graphical overview of the global burden of injuries. World Health Organization, GenevaGoogle Scholar
  28. 28.
    Ifesanya AO, Omololu AB, Ogunlade SO, Alonge TO (2010) The burden of open fractures of the tibia in a developing economy. Nigerian J Plast Surg 6(1). Available at
  29. 29.
    World Health Organization (2006) Obstetric fistula: guiding principles for clinical management and programme development. World Health Organization, GenevaGoogle Scholar
  30. 30.
    Adewole OA, Giwa SO, Kayode MO, Shoga MO, Balogun RA (2009) Congenital club foot in a teaching hospital in Lagos, Nigeria. Afr J Med Med Sci 38(2):203–206PubMedGoogle Scholar
  31. 31.
    Adegbehingbe OO, Oginni LM, Ogundele OJ, Ariyibi AL, Abiola PO, Ojo OD (2010) Ponseti clubfoot management: changing surgical trends in Nigeria. Iowa Orthop J 30:7–14PubMedGoogle Scholar
  32. 32.
    Alkire B, Hughes CD, Nash K, Vincent JR, Meara JG (2011) Potential economic benefit of cleft lip and palate repair in sub-Saharan Africa. World J Surg 35(6):1194. doi: 10.1007/s00268-011-1055-1 PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2012

Authors and Affiliations

  • Jaymie A. Henry
    • 1
    Email author
  • Olubayo Windapo
    • 2
  • Adam L. Kushner
    • 3
    • 4
  • Reinou S. Groen
    • 3
    • 5
  • Benedict C. Nwomeh
    • 3
    • 6
  1. 1.EducationSurgeons OverSeas (SOS)San FranciscoUSA
  2. 2.Polybonde Medical ServicesLagosNigeria
  3. 3.Surgeons OverSeas (SOS)New YorkUSA
  4. 4.Department of SurgeryColumbia UniversityNew YorkUSA
  5. 5.Royal Tropical InstituteAmsterdamThe Netherlands
  6. 6.Department of Pediatric SurgeryNationwide Children’s HospitalColumbusUSA

Personalised recommendations