The Evolution of the Specialist Surgeon Workforce in East, Central and Southern Africa

Background: Access to surgery across sub-Saharan Africa faces persistent challenges with substantial disparity between disease burden and the surgical workforce. This updated situational analysis of specialist surgeons was undertaken to monitor progress toward global surgery development goals and address workforce deficits. Methods: A cross-sectional analysis of the surgeon workforce across 12 of the 14 member countries of The College of Surgeons of East, Central and Southern Africa (COSECSA) was conducted between 2021 and 2022. The data was validated by at least two sources, including medical council registers and direct contact with surgeons via COSECSA Country representatives. Results were compared to data collection undertaken in 2015. Results: 2555 surgeons were identified as practising within the region, a 42% increase since 2015. This represents a rise of only 0.06 surgeons per 100,000. Surgeon density varies widely, with an 18-fold difference between the lowest (Mozambique, 0.22/100,000) and the highest surgeon densities (Namibia, 3.97/100,000). Women surgeons constitute one-tenth of the surgical workforce, a figure stagnant since 2015. Most surgeons (58%) practice in highly populated areas, and 78% work in their country of primary qualification. Conclusion: Currently there is a higher rate of population growth relative to surgical workforce expansion. Innovative approaches in surgical training are crucial to meet 2030 workforce targets. The non-progression in the ratio of female to male surgeons demands attention. Future workforce planning should recognize the growing impact of female doctors on the healthcare workforce and prioritize strategies to support women in surgical careers.