Royal College of Surgeons in Ireland
Financing of surgery and anaesthesia in sub-Saharan....pdf (1.08 MB)

Financing of surgery and anaesthesia in sub-Saharan Africa: a scoping review

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journal contribution
posted on 2022-12-20, 14:08 authored by Martilord Ifeanyichi, Ellis Aune, Mark Shrime, Jakub GajewskiJakub Gajewski, Chiara PittalisChiara Pittalis, John Kachimba, Eric Borgstein, Ruairi BrughaRuairi Brugha, Rob Baltussen, Leon Bijlmakers

Objective: This study aimed to provide an overview of current knowledge and situational analysis of financing of surgery and anaesthesia across sub-Saharan Africa (SSA).

Setting: Surgical and anaesthesia services across all levels of care-primary, secondary and tertiary.

Design: We performed a scoping review of scientific databases (PubMed, EMBASE, Global Health and African Index Medicus), grey literature and websites of development organisations. Screening and data extraction were conducted by two independent reviewers and abstracted data were summarised using thematic narrative synthesis per the financing domains: mobilisation, pooling and purchasing.

Results: The search resulted in 5533 unique articles among which 149 met the inclusion criteria: 132 were related to mobilisation, 17 to pooling and 5 to purchasing. Neglect of surgery in national health priorities is widespread in SSA, and no report was found on national level surgical expenditures or budgetary allocations. Financial protection mechanisms are weak or non-existent; poor patients often forego care or face financial catastrophes in seeking care, even in the context of universal public financing (free care) initiatives.

Conclusion: Financing of surgical and anaesthesia care in SSA is as poor as it is underinvestigated, calling for increased national prioritisation and tracking of surgical funding. Improving availability, accessibility and affordability of surgical and anaesthesia care require comprehensive and inclusive policy formulations.


European Commission’s Horizon 2020 Framework Programme, under grant agreement no: 733391, as part of the Scaling up Safe Surgery for District and Rural Populations in Africa (SURG-Africa) project



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Published Citation

Ifeanyichi M. et al. Financing of surgery and anaesthesia in sub-Saharan Africa: a scoping review. BMJ Open. 2021;11(10):e051617.

Publication Date

19 October 2021

PubMed ID



  • Institute of Global Surgery
  • Public Health and Epidemiology


BMJ Publishing Group Ltd


  • Published Version (Version of Record)