World Journal of Surgery

, Volume 40, Issue 8, pp 1865–1873 | Cite as

Challenges and Opportunities in the Provision of Surgical Care in Vanuatu: A Mixed Methods Analysis

  • S. YoungEmail author
  • W. R. G. Perry
  • B. Leodoro
  • V. Nosa
  • I. Bissett
  • J. A. Windsor
  • A. J. Dare
Original Scientific Report



The Pacific island nation of Vanuatu faces a number of challenges in delivering surgical care to its population. We aimed to understand and document the barriers, opportunities and required actions to improve surgical care in the country using a mixed methods analysis which incorporated the perspectives of local health stakeholders.


A baseline quantitative assessment of surgical capacity in Vanuatu was carried out using the WHO situational analysis tool. Twenty semi-structured interviews were then conducted on the two main islands (Efate and Espiritu Santo) with surgeons, allied health staff, health managers, policy-makers and other key stakeholders, using a grounded theory qualitative case study methodology. Initial informants were identified by purposive sampling followed by snowball sampling until theoretical saturation was reached. Interviews were open and axially coded with subsequent thematic analysis.


Vanuatu faces deficits in surgical infrastructure, equipment and human resources, especially in the rural provinces. Geographic isolation, poverty and culture—including the use of traditional medicine and low health literacy—all act as barriers to patients accessing timely surgical care. Issues with governance, human resourcing and perioperative care were commonly identified by stakeholders as key challenges facing surgical services. Increasing outreach clinics, developing efficient referral systems, building provincial surgical capacity and undertaking locally led research were identified as key actions that can improve surgical care.


Documenting locally identified challenges and opportunities for surgical care in Vanuatu is an important first step towards developing formal strategies for improving surgical services at the country level.


Health Literacy Surgical Care Surgical Service Qualitative Case Study Western Pacific Region 
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.


Compliance with ethical standards

Conflict of interest

No conflicts of interest. Salary costs for Steven Young were met by University of Auckland Studentship fund and travel costs met by the University of Auckland Department of Surgery.

Supplementary material

268_2016_3535_MOESM1_ESM.docx (37 kb)
Supplementary material 1 (DOCX 37 kb)


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Copyright information

© Société Internationale de Chirurgie 2016

Authors and Affiliations

  • S. Young
    • 1
    Email author
  • W. R. G. Perry
    • 1
  • B. Leodoro
    • 2
  • V. Nosa
    • 3
  • I. Bissett
    • 1
  • J. A. Windsor
    • 1
  • A. J. Dare
    • 1
  1. 1.Global Surgery Group, Department of Surgery, Faculty of Medical and Health SciencesThe University of AucklandAucklandNew Zealand
  2. 2.Northern Provincial HospitalEspiritu SantoVanuatu
  3. 3.Pacific Health Section, School of Population HealthUniversity of AucklandAucklandNew Zealand

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