EXPLORING THE CONCEPT OF SURGICAL TRANSITION: SURGICAL ACTIVITY IN THE LIGHT OF ECONOMIC DEVELOPMENT IN SIERRA LEONE, LIBERIA, GHANA AND INDIA juulbakker@gmail.com

 

EXPLORING THE CONCEPT OF SURGICAL TRANSITION: SURGICAL ACTIVITY IN THE LIGHT OF ECONOMIC DEVELOPMENT IN SIERRA LEONE, LIBERIA, GHANA AND INDIA

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Anita Gadgil anitgadgil@gmail.com The George Institute for Global Health WHO Collaborating Centre for Emergency, Critical and Operative Care New Delhi India

Håkon A. Bolkan hakon.a.bolkan@ntnu.no Norwegian University of Science and Technology Department of Public Health and Nursing Trondheim Norway

Norway

Oral or Poster

The surgical volume indicator measures surgical activity within a population but does not fully reveal the details behind this statistic. As health systems evolve and countries develop economically, variations in surgery types, providers, and care levels provide deeper insights into surgical activity changes. This study analyzed surgical data from four diverse settings to assess patient characteristics, surgical staff, case distribution, care levels, and anesthesia, forming a basis for a “surgical transition” framework.

A secondary analysis was performed on surgical volume data from four studies in Sierra Leone, Liberia, Ghana, and India. Descriptive statistics compared surgical volumes by population subgroups, surgical providers, case distribution, care level, and anesthesia practices.

Higher GDP per capita countries had greater surgical volumes, more specialists, and a broader, more advanced case mix. In lower-income settings, surgeries mostly involved cesarean sections or procedures for women of reproductive age, whereas older populations had more surgeries in advanced economies. The proportion of essential surgeries (e.g., obstetric complications, emergencies, injuries) remained stable between low- to lower-middle-income countries but declined with further development. Specialist-performed surgeries increased with economic growth, expanding case variety and complexity.

Surgical volume changes reflect broader societal and economic development. The “surgical transition” concept links demographic and socioeconomic progress to surgical quantity, diversity, and complexity. Each transition phase presents unique challenges, and identifying these phases can guide tailored healthcare policies, financing, infrastructure, and delivery strategies. This approach makes surgical indicators more actionable for measuring progress and comparing health systems globally.