Article Text


Retrospective review of Surgical Availability and Readiness in 8 African countries
  1. D A Spiegel1,
  2. B Droti2,
  3. P Relan3,
  4. S Hobson4,
  5. M N Cherian2,
  6. K O'Neill2
  1. 1Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
  2. 2World Health Organization, Geneva, Switzerland
  3. 3North Shore University Hospital, Manhasset, New York, USA
  4. 4Emory University School of Medicine, Atlanta, Georgia, USA
  1. Correspondence to Dr D A Spiegel; spiegeld{at}


Objectives The purpose of this study was to assess surgical availability and readiness in 8 African countries using the WHO's Service Availability and Readiness Assessment (SARA) tool.

Setting We analysed data for surgical services, including basic and comprehensive surgery, comprehensive obstetric care, blood transfusion, and infection prevention, obtained from the WHO's SARA surveys in Sierra Leone, Uganda, Mauritania, Benin, Zambia, Burkina Faso, Democratic Republic of Congo and Togo.

Primary and secondary outcome measures Among the facilities that were expected to offer surgical services (N=3492), there were wide disparities between the countries in the number of facilities per 100 000 population that reported offering basic surgery (1.0–12.1), comprehensive surgery (0.1–0.8), comprehensive obstetric care (0.1–0.8) and blood transfusion (0.1–0.8). Only 0.1–0.3 facilities per 100 000 population had all three bellwether procedures available, namely laparotomy, open fracture management and caesarean section. In all the countries, the facilities that reported offering surgical services generally had a shortage of the necessary items for offering the services and this varied greatly between the countries, with the facilities having on average 27–53% of the items necessary for offering basic surgery, 56–83% for comprehensive surgery, 49–72% for comprehensive obstetric care and 54–80% for blood transfusion. Furthermore, few facilities had all the necessary items present. However, facilities that reported offering surgical services had on average most of the necessary items for the prevention of infection.

Conclusions There are important gaps in the surgical services in the 8 African countries surveyed. Efforts are therefore urgently needed to address deficiencies in the availability and readiness to deliver surgical services in these nations, and this will require commitment from multiple stakeholders. SARA may be used to monitor availability and readiness at regular intervals, which will enable stakeholders to evaluate progress and identify gaps and areas for improvement.

  • Africa
  • Surgical services
  • Deficiencies
  • SARA

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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  • Contributors DAS contributed to project design, data analysis and drafted the manuscript. KO responsible for project design, contributed to data analysis and critical revisions of the manuscript. BD collected and analysed the data, codrafted the manuscript. MNC contributed to project design and reviewed the manuscript, SH contributed to data collection and revision of the manuscript. PR contributed to data collection and revision of the manuscript.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests The authors include WHO staff, and the views expressed in this publication reflect their views and not necessarily that of WHO. One of the authors (DAS) has served as a consultant for the WHO.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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