Abstract
BACKGROUND: District hospitals (DHs) are essential providers of surgical care in low- and middle-income countries. Despite recommendations to strengthen DH surgical services, data on South African DH surgical capacity remain limited. This study describes the volume, scope and workforce of surgical services at a rural Eastern Cape DH over 7 years. METHODS: A retrospective audit of all surgical procedures (January 2016-December 2022) was conducted using theatre register data. Patient demographics, procedure type and surgical provider were extracted to analyse trends in surgical volume, scope and workforce. RESULTS: A total of 2616 operations were performed, predominantly in females (97%), with a median age of 25 years. Statistical process control analysis showed a significant upward shift in the mean monthly surgical volume from 27 to 41 procedures. The surgical scope expanded from 14 different types of procedures in 2016 to 25 in 2022, covering obstetrics, gynaecology, general surgery, orthopaedics and urology. Caesarean sections accounted for 82% of procedures. Family medicine registrars and specialists performed the highest number of procedures per person. CONCLUSION: Surgical services expanded in both volume and scope, demonstrating the capacity of district-level facilities to meet essential surgical needs.Contribution: This study provides rare longitudinal data on rural South African DH surgical services, highlighting the critical role of decentralised family medicine training and senior staffing in supporting surgical expansion and strengthening district-level care.