Evidence map›Paper›PMID 40335078›Full record

Observational studyBMJ global health2025

The impact of surgical task-sharing in Sierra Leone: a nationwide longitudinal observational study on surgical workforce and volume, 2012-2023.

Mali Eggen Furre, Maria Svengaard, Elisabeth Øvreås, Alex J van Duinen, Thomas Ashley, Martin P Grobusch, Juul Bakker, Jaap Gunneweg, Nobhojit Roy, Mustapha S Kabba and 1 more

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMJ global health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Trial
  2. Article
  3. Article
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  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Mali Eggen Furre *Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.ORCID http://orcid.org/0009-0006-6046-567X
Maria Svengaard *Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.ORCID http://orcid.org/0009-0001-7018-8489
Elisabeth ØvreåsDepartment of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
Alex J van DuinenDepartment of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.ORCID http://orcid.org/0000-0002-6943-0100
Thomas AshleyMinistry of Health, Freetown, Sierra Leone.
Martin P GrobuschDepartment of Infectious Diseases, Amsterdam University Medical Centres, Amsterdam, The Netherlands.
Juul BakkerDepartment of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
Jaap GunnewegCapaCare, Masanga, Sierra Leone.
Nobhojit RoyUniversity of Global Health Equity, Kigali, Gasabo, Rwanda.
Mustapha S Kabba *Ministry of Health, Freetown, Sierra Leone.
Håkon Angell Bolkan *Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway hakon.a.bolkan@ntnu.no.ORCID http://orcid.org/0000-0002-9609-4093

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundA surgical task-sharing programme was initiated by the Sierra Leonean Ministry of Health in 2011 to enhance public surgical capacity and equalise access between urban and rural populations by redistributing surgical tasks within a limited healthcare workforce.

methodsThis longitudinal nationwide study, involving all healthcare facilities with an operating theatre in Sierra Leone, analysed changes in volume and population rates of surgery and distribution of surgical resources before (2012), 5 (2017) and 10 years after (2023) the initiative was introduced.

resultsSurgical volume rates increased from 400 to 505 procedures per 100 000 population between 2012 and 2023. The public sector became the main provider, performing 56.0% of all operations in 2023, up from 39.6% in 2012. Rural surgeries increased by 77.6% over the decade, almost two times more than in urban areas. In rural areas, there was a transition from non-specialised physicians performing 46.2% of operations in 2012, to task-shared associate clinicians performing 55.1% (95% CI 49.5% to 60.7%) in 2023, making them the main surgical provider. Nationwide caesarean section rates increased from 1.4% (2012) to 5.3% (95% CI 4.6% to 6.0%) (2023). Caesarean sections were in 2023 mostly performed in public facilities (81.3%, 95% CI 80.1.0% to 82.5%) by associate clinicians (57.6%, 95% CI 53.2% to 61.9%).

conclusionsOver the last decade, Sierra Leone has seen a shift in surgical care, with a transition from general to obstetric surgeries, from private to public institutions, and an expansion of surgical care in rural areas, with associate clinicians as the leading provider. The introduction of a nationwide surgical task-sharing initiative to strengthen the surgical workforce at district governmental hospitals in 2011 has emerged as the major contributor to the change in surgical activity and output observed in Sierra Leone over the last decade.

Indexed as

Health WorkforceSurgical Procedures, OperativeFemaleHumansLongitudinal StudiesSierra LeoneGlobal HealthHealth education and promotionHealth PersonnelHealth systems evaluationSurgery

Identifiers

PMID40335078
PMCPMC12056624

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.