Critical Shortages in Pediatric Surgical Care Across West Africa: A Workforce Density Projection.

Abstract

Background: West Africa faces severe pediatric surgeon (PS) shortages amidst a rapidly growing youth population and high surgical disease burden. The recommended benchmark is one PS per 100,000 children. However, persistent workforce gaps, driven by migration, limited training, and infrastructure constraints, hinder care. To guide regional capacity building, this study assessed the pediatric surgeon workforce density (PSWD) across 13 West African College of Surgeons (WACS) member nations and modeled projected workforce requirements.

Methods: Using 2023 UNICEF population data and 2024 workforce records, we conducted a cross-sectional analysis of PSWD. Population-based modeling was utilized to project the number of PS needed to achieve target densities over 5, 10, and 20 years, comparing Anglophone and Francophone countries.

Results: No country achieved the 1:100,000 benchmark, with most falling below a PSWD of 0.2 per 100,000 children. The overall regional PSWD was 0.16 per 100,000 children, representing only 341 surgeons for 212 million children. Senegal recorded the highest density (0.63 per 100,000), while Gambia and Liberia had none. Francophone countries averaged a higher density (0.25 per 100,000) than Anglophone nations (0.05 per 100,000). Nigeria faces the largest absolute deficit, requiring 970 additional surgeons. Regionally, there is a total shortfall of 1,776 pediatric surgeons. Closing this gap within five years would require training and retaining 406 new surgeons annually.

Conclusion: West Africa suffers from critical PSWD deficits, leaving millions without adequate surgical care. Coordinated regional efforts to dramatically expand fellowship training and implement robust retention strategies are urgently required to build sustainable pediatric surgical capacity.