World Journal of Surgery

, Volume 43, Issue 3, pp 704–714 | Cite as

Assessment of Capacity to Meet Lancet Commission on Global Surgery Indicators in the Federal Capital Territory, Abuja, Nigeria

  • Jamie E. Anderson
  • Aliyu Baba Ndajiwo
  • Susuti Aaron Nuhu
  • Olubunmi Aiyedun Lawal
  • Joseph O. Amedu
  • Emmanuel A. AmehEmail author
Surgery in Low and Middle Income Countries



This is a baseline assessment of surgical capacity in the Federal Capital Territory (FCT), in preparation for the creation of a National Surgical, Obstetric, Anesthesia, and Nursing Plan.


In October 2017, all 10 of the 11 secondary hospitals in FCT that provide surgical and/or obstetric care were surveyed using a modified World Health Organization Hospital Assessment Tool and a qualitative semi-structured hospital interview tool of the medical Director (MdD). This project received approval from the Nigeria Federal Ministry of Health and the FCT Department of Health and Human Services.


The number of inpatient beds ranged from 35 to 140, and the number of admissions ranged from 1200 to 6400 patients per year. The mean number of surgeries performed in 2016 by these hospitals was 783 (range 235–1601). Cesarean section was the most common surgical procedure at each hospital. Only five hospitals regularly performed laparotomies. Only three hospitals regularly performed fixation of open fractures. Of 152 surgical, obstetric, and anesthesia providers, all hospitals had at least one consultant obstetrician, but only four hospitals had a general surgeon and three hospitals had a consultant anesthesiologist. Deficient physical space for inpatient admissions was the most common concern of MdDs.


The FCT reaches the target for 2-h access, with 80% of patients (on average) reaching the hospital within 2 h. However, SAO provider density, surgical volume, and tracking of the perioperative mortality rate were low. Data were lacking to comment on protection against impoverishing and catastrophic expenditures.



The authors thank the Federal Ministry of Health and the Federal Capital Territory Department of Health and Human Services for their assistance in this project. We also thank the National Hospital Abuja for their generous logistical support.


Dr. Anderson was funded through support from the Ronda Stryker and William Johnston Global Surgery Fellowship Fund at Harvard Medical School.

Compliance with ethical standards

Conflicts of interest

All authors declare that they have no conflict of interest.

Supplementary material

268_2018_4835_MOESM1_ESM.pdf (268 kb)
Supplementary material 1 (PDF 267 kb)
268_2018_4835_MOESM2_ESM.pdf (486 kb)
Supplementary material 2 (PDF 485 kb)


  1. 1.
    Meara JG, Leather AJ, Hagander L et al (2015) Global surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet 386:569–624CrossRefGoogle Scholar
  2. 2.
    O’Neill KM, Greenberg SL, Cherian M et al (2016) Bellwether procedures for monitoring and planning essential surgical care in low- and middle-income countries: caesarean delivery, laparotomy, and treatment of open fractures. World J Surg 40:2611–2619. CrossRefGoogle Scholar
  3. 3.
    Kim YR, Kwakye G, Kwok AC et al (2015) Sustainability and long-term effectiveness of the WHO surgical safety checklist combined with pulse oximetry in a resource-limited setting: a two-year update from Moldova. JAMA Surg 150:473–479CrossRefGoogle Scholar
  4. 4.
    Vivekanantham S, Ravindran RP, Shanmugarajah K et al (2014) Surgical safety checklists in developing countries. Int J Surg 12:2–6CrossRefGoogle Scholar
  5. 5.
    Henry JA, Windapo O, Kushner AL et al (2012) A survey of surgical capacity in rural southern Nigeria: opportunities for change. World J Surg 36:2811–2818. CrossRefGoogle Scholar
  6. 6.
    Okoye MT, Nguyen ET, Kushner AL et al (2016) Can economic performance predict pediatric surgical capacity in sub-Saharan Africa? World J Surg 40:1336–1343. CrossRefGoogle Scholar
  7. 7.
    Krishnaswami S, Nwomeh BC, Ameh EA (2016) The pediatric surgery workforce in low- and middle-income countries: problems and priorities. Semin Pediatr Surg 25:32–42CrossRefGoogle Scholar
  8. 8.
    Chirdan LB, Ameh EA, Abantanga FA et al (2010) Challenges of training and delivery of pediatric surgical services in Africa. J Pediatr Surg 45:610–618CrossRefGoogle Scholar
  9. 9.
    Chukuezi AB, Nwosu JN (2010) Mortality pattern in the surgical wards: a five year review at Federal Medical Centre, Owerri, Nigeria. Int J Surg 8:381–383CrossRefGoogle Scholar
  10. 10.
    Onyemaechi NO, Popoola SO, Schuh A et al (2015) Mortality pattern of hospitalized surgical patients in a Nigerian Tertiary Hospital. Indian J Surg 77:881–885CrossRefGoogle Scholar
  11. 11.
    Ayoade BA, Thanni LO, Shonoiki-Oladipupo O (2013) Mortality pattern in surgical wards of a university teaching hospital in southwest Nigeria: a review. World J Surg 37:504–509. CrossRefGoogle Scholar
  12. 12.
    Ekeke ON, Okonta KE, Igwe PO (2016) Surgical inpatient mortality in a Nigerian Tertiary Hospital. Niger J Clin Pract 19:308–312CrossRefGoogle Scholar
  13. 13.
    Ekenze SO, Modekwe VO, Ajuzieogu OV, Asinobi IO, Sanusi J (2017) Neonatal surgery in a developing country: outcome of co-ordinated interdisciplinary collaboration. J Paediatr Child Health 53:976–980CrossRefGoogle Scholar
  14. 14.
    Ilori IU, Ituen AM, Eyo CS (2013) Factors associated with mortality in neonatal surgical emergencies in a developing tertiary hospital in Nigeria. Open J Paediatr 3:231–235CrossRefGoogle Scholar
  15. 15.
    Taliabi AO, Sowande OA, Adenekan AT et al (2018) A 10-year retrospective review of perioperative mortality in pediatric general surgery at Ile-Ife Hospital, Nigeria. J Pediatr Surg. Epub ahead of printGoogle Scholar
  16. 16.
    Ekwunife OH, Okpata A, Ugwu JO et al (2015) Outcome of neonatal surgeries in Nnewi, Nigeria. Ann Pediatr Surg 11:132–135CrossRefGoogle Scholar
  17. 17.
    Idakwo U, Olawoye O, Ajayi BGK et al (2018) Exfoliation syndrome in Northern Nigeria. Clin Opthalmol 12:271–277. Figure reproduced from National Identify Management Commission: Accessed 11 June 2018
  18. 18.
    Adapted from the Ministry of Land, Planning and Survey Abuja (2005) Accessed 11 June 2018
  19. 19.
    World Health Organization (2012) Guide to infrastructure and supplies at various levels of health care facilities. Accessed 15 April 2018
  20. 20.
    McCord C, Kruk ME, Mock CN et al (2015) Chapter 12: organization of essential services and the role of first-level hospitals. In: Disease control priorities, 3rd edn, volume 1 essential surgery. World Bank, Washington. Accessed 15 April 2018
  21. 21.
    National Population Commission (NPC) [Nigeria] and ICF International (2014) Nigeria Demographic and Health Survey 2013. NPC and ICF International, Abuja and RockvilleGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Jamie E. Anderson
    • 1
    • 2
    • 3
  • Aliyu Baba Ndajiwo
    • 1
  • Susuti Aaron Nuhu
    • 1
    • 4
  • Olubunmi Aiyedun Lawal
    • 1
    • 5
  • Joseph O. Amedu
    • 1
    • 4
  • Emmanuel A. Ameh
    • 1
    • 6
    Email author
  1. 1.Nigeria National Surgical, Obstetric, AnesthesiaNursing Plan CommitteeAbujaNigeria
  2. 2.Harvard Medical School Program for Global Surgery and Social ChangeBostonUSA
  3. 3.Department of SurgeryUniversity of California, DavisSacramentoUSA
  4. 4.Department of Hospital ServicesFederal Ministry of HealthAbujaNigeria
  5. 5.National Association of Nigerian Paediatric NursesAbujaNigeria
  6. 6.Division of Paediatric Surgery, Department of SurgeryNational HospitalAbujaNigeria

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