ArticleBMJ open2021
Barriers to increase surgical productivity in Sierra Leone: a qualitative study.
Article in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed, 11 citations in OpenAlex.
- Non-operative versus operative management of uncomplicated acute appendicitis: a randomized controlled study in Sierra Leone.BMC surgery · 2026Trial
- Challenges and enablers in accessing paediatric inguinal hernia surgical care in Sierra Leone: a qualitative exploratory study.BMJ open · 2026Article
- Article
- Access to surgery in Ecuador using the enhanced 2-step floating catchment area approach.BMC global and public health · 2026Article
- Employed but Unpaid, Volunteers or Paradoxical Surplus? Sierra Leone's Unsalaried Health Workforce.The International journal of health planning and management · 2026Article
- Development of paediatric surgical care in Sierra Leone: a repeated nationwide cross-sectional study from 2012 to 2023.BMJ public health · 2026Article
- Surgical Volume in Sierra Leone: A Comparison Between Population and Facility-Based Data Collection.World journal of surgery · 2025Article
- The impact of surgical task-sharing in Sierra Leone: a nationwide longitudinal observational study on surgical workforce and volume, 2012-2023.BMJ global health · 2025Observational
- Exploring the concept of surgical transition: surgical activity in the light of economic development in Sierra Leone, Liberia, Ghana and India.Frontiers in surgery · 2025Article
- Unsalaried health workers in Sierra Leone: a scoping review of the literature to establish their impact on healthcare delivery.International journal for equity in health · 2023Article
- Prevalence, incidence, repair rate, and morbidity of groin hernias in Sierra Leone: cross-sectional household study.BJS open · 2023Article
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Authors and funding
12 authors at 3 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo explore factors influencing surgical provider productivity and identify barriers against and opportunities to increase individual surgical productivity in Sierra Leone, in order to explain the observed increase in unmet surgical need from 92.2% to 92.7% and the decrease in surgical productivity to 1.7 surgical procedures per provider per week between 2012 and 2017. DESIGN AND
methodsThis explanatory qualitative study consisted of in-depth interviews about factors influencing surgical productivity in Sierra Leone. Interviews were analysed with a thematic network analysis and used to develop a conceptual framework. PARTICIPANTS AND
setting21 surgical providers and hospital managers working in 12 public and private non-profit hospitals in all regions in Sierra Leone.
resultsSurgical providers in Sierra Leone experience a broad range of factors within and outside the health system that influence their productivity. The main barriers involve both patient and facility financial constraints, lack of equipment and supplies, weak regulation of providers and facilities and a small surgical workforce, which experiences a lack of recognition. Initiation of a Free Health Care Initiative for obstetric and paediatric care, collaborations with partners or non-governmental organisations, and increased training opportunities for highly motivated surgical providers are identified as opportunities to increase productivity. DISCUSSION: Broader nationwide health system strengthening is required to facilitate an increase in surgical productivity and meet surgical needs in Sierra Leone. Development of a national strategy for surgery, obstetrics and anaesthesia, including methods to reduce financial barriers for patients, improve supply-mechanisms and expand training opportunities for new and established surgical providers can increase surgical capacity. Establishment of legal frameworks and appropriate remuneration are crucial for sustainability and retention of surgical health workers.
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