Outcomes After Elective Inguinal Hernia Repair Performed by Associate Clinicians vs Medical Doctors in Sierra Leone

Abstract

Surgical conditions account for a large burden of disease, but 5 billion people do not have access to timely, high-quality surgical services at an affordable cost.¹ Capacity to meet the immense need for surgical care remains very limited. The human resource crisis includes a pronounced scarcity of specialist surgeons in sub-Saharan Africa.¹ In 2015, the 68th World Health Assembly² passed a resolution on emergency and essential surgical and anesthesia care as an important part of universal health coverage. Task sharing was expressed as a part of the solution to the human resource shortage in surgery.² Task sharing is the pragmatic sharing of clinical tasks among specialist and nonspecialist medical doctors (MDs) and midlevel health care workers, commonly called associate clinicians (ACs), who have an educational level between that of a nurse and an MD.^3,4 The safety and effectiveness of surgical task sharing with ACs has been previously demonstrated in obstetric surgery.^5-8 Surgery performed by MDs is often considered standard care, but very little research on task sharing with MDs exists.⁹ The level of evidence to support task sharing in general surgery is very limited.