Abstract
BACKGROUND: In Ethiopia and other low-and middle-income countries, access to emergency and elective surgical care is still inadequate and inequitable. Ethiopia has initiated a nationwide strategic plan aimed at tackling obstacles within the surgical system. The aim of this study was to assess surgical and anesthesia care capacity and productivity in high volume Ethiopian hospitals. METHODS: An explanatory mixed-methods study was conducted in 24 high-volume public hospitals across Ethiopia's 10 regions and 2 city administrations. Data were collected through structured document reviews, site observations, and interviews using a validated WHO-aligned tool. Quantitative data were analyzed using SPSS, and qualitative responses were thematically analyzed using ATLAS.ti. RESULTS: Addis Ababa hosts over 60% of the national surgical workforce, highlighting stark regional disparities. While 80% of hospitals reported adequate infrastructure, site observations revealed functional inconsistencies in PACU design, sterilization units, and equipment availability. Only 77% of hospitals consistently implemented patient monitoring and handover protocols. Surgical productivity was low, with an average of 2.5 surgeries per week per clinician and 52.39% annual workforce productivity. Best practices included the use of EMRs, backlog-reduction campaigns, and daily interdisciplinary briefings. However, persistent challenges included inadequate staffing, poor infrastructure, and uneven adoption of safety protocols. CONCLUSION AND RECOMMENDATION: Ethiopia's surgical system shows promising innovations in select hospitals, yet national scale-up is hindered by infrastructure gaps, uneven workforce distribution, and inconsistent safety practices. Addressing these challenges requires data-driven planning, targeted investment in underserved regions, and expanded use of digital systems and collaborative networks to promote best practice adoption across facilities.