Shortage of surgeons, obstetricians and anesthesiologist in low and middle income countries

Purpose: A lack of surgical providers is a major barrier to essential surgical care worldwide. It is is particularly concerning due to the rising burden of non-communicable diseases, many of which require surgical treatment, and the ongoing crisis in maternal mortality. The goal of this research was to gather data about the number of surgeons, obstetricians and anesthesiologists world-wide, and to assess the correlation between national surgical physician density and maternal mortality. Materials and Methods: We performed a systematic review of the English-language literature about surgeons, obstetrician and anesthesiologists in LMICs. We also consulted WHO, OECD, and surgical society websites. Results: Across LMICs, general surgeon density ranged from 0.13 to 1.57 per 100,000 people; obstetrician density ranged from 0.042 to 12.5; and anesthesiologist density ranged from 0 to 4.9. Maternal mortality decreased 14% for every unit increase in surgical physician per 1,000, controlling for both health expenditure as percent of GDP and rates of skilled birth attendance (p=0.018). Only five LMICs were described in terms of surgeons, obstetricians, and anesthesiologists. Conclusion and policy implications: Surgical physician density can be 100 times lower in LMICs than in HICs. Surgery workforce data may be essential health systems indicators, but are often unavailable for LMICs. The Global Surgery Workforce Initiative is currently surveying Ministries of Health and professional organizations to determine the number of surgical providers in LMICs. GWSI data will describe the global surgical workforce and inform surgical systems strengthening efforts on international and national levels.