Furre Mali Eggen, Svengaard Maria, Øvreås Elisabeth, van Duinen Alex J, Ashley Thomas, Grobusch Martin P, Bakker Juul, Gunneweg Jaap, Roy Nobhojit, Kabba Mustapha S, Bolkan Håkon Angell
Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
Clinic of Surgery, Trondheim University Hospital St Olav's Hospital, Trondheim, Norway.
BMJ Glob Health. 2025 May 6;10(5):e018423. doi: 10.1136/bmjgh-2024-018423.
A 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.
This 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.
Surgical 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%).
Over 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.
2011年，塞拉利昂卫生部启动了一项手术任务分担计划，通过在有限的医疗劳动力中重新分配手术任务，提高公共手术能力，并使城乡人口获得的医疗服务更加均等。
这项全国性纵向研究涵盖了塞拉利昂所有设有手术室的医疗机构，分析了该计划实施前（2012年）、实施5年后（2017年）和10年后（2023年）手术量、手术人口率以及手术资源分配的变化。
2012年至2023年间，每10万人口的手术量从400例增加到505例。公共部门成为主要提供者，2023年进行了所有手术的56.0%，高于2012年的39.6%。在这十年间，农村地区的手术量增加了77.6%，几乎是城市地区的两倍。在农村地区，手术提供者从2012年非专科医生进行46.2%的手术，转变为2023年任务分担的助理临床医生进行55.1%（95%置信区间49.5%至60.7%）的手术，使他们成为主要的手术提供者。全国剖宫产率从2012年的1.4%升至2023年的5.3%（95%置信区间4.6%至6.0%）。2023年，剖宫产大多在公共机构进行（81.3%，95%置信区间80.1%至82.5%），由助理临床医生实施（57.6%，95%置信区间53.2%至61.9%）。
在过去十年中，塞拉利昂的外科护理发生了转变，从普通外科手术转向产科手术，从私立机构转向公共机构，农村地区的外科护理得到扩展，助理临床医生成为主要提供者。2011年在地区政府医院引入的全国性手术任务分担计划，已成为过去十年塞拉利昂外科活动和产出变化的主要促成因素。
