Abstract
BACKGROUND: Low- and middle- income countries face a surgical workforce shortage amidst a high burden of diseases amenable to surgery. Rural Nigeria, which is mainly supported by primary health care, lacks access to timely, affordable and safe surgical care, leading to high morbidity and mortality. This review aims to assess the burden of lack of personnel, evaluate current innovative strategies, and provide future directions for rural surgical workforce development in Nigeria. METHODS: A total of 79 articles were included in this review. A comprehensive literature search was conducted in PubMed/MEDLINE and Google Scholar for articles published up to December 2024. Search terms included "rural surgical practice," "rural surgery challenges," "rural surgical care," and "Nigeria." Eligible studies included observational studies, systematic reviews, meta-analyses, and narrative reviews. Only full-text articles published in English were considered. Two reviewers independently screened articles for relevance and determined inclusion based on predefined criteria. RESULTS: The review revealed models such as government-led initiatives, task-shifting, mobile surgical units, private and mission hospitals, and surgical outreach programs which are aimed at improving surgical care delivery in rural Nigeria. We also identified global strategies such as rural surgery residency programs, incentivization, and telemedicine, which have been adopted in other countries to address workforce challenges in rural areas. Existing models in Nigeria demonstrate both capabilities and constraints. Strategies such as government-led initiatives and task-shifting which involve the deployment of locally-trained staff in rural centers are limited by lack of required infrastructure and technology, as well as ethical concerns on the quality of care. Although the problem of accessibility is partly addressed in some settings with Mobile Surgical Units and private hospitals, there are significant challenges bordering on patient selection and affordability respectively. Furthermore, mission hospitals and surgical outreach programs occasionally provide surgical services among underserved populations at subsidized or no cost. However, financial sustainability is a major challenge for these programs which rely heavily on donor funding. CONCLUSION: This study aims to explore current global strategies being implemented to address rural surgical workforce shortage, identifying strengths and weaknesses in a bid to assess reproducibility in the Nigerian context. Unequal distribution of workforce has greatly affected the delivery of surgical care in rural areas in Nigeria. Current models are faced with limitations and innovative solutions are needed to address existing challenges in rural healthcare. Further investment is also required to provide timely and efficient surgical healthcare in rural Nigeria.