World Journal of Surgery

, Volume 43, Issue 5, pp 1185–1192 | Cite as

Identifying Information Gaps in a Surgical Capacity Assessment Tool for Developing Countries: A Methodological Triangulation Approach

  • Obieze C. Nwanna-Nzewunwa
  • Mary Margaret Ajiko
  • Girish Motwani
  • Fiona Kabagenyi
  • Melissa Carvalho
  • Isabelle Feldhaus
  • Fred Kirya
  • Joseph Epodoi
  • Rochelle Dicker
  • Catherine JuillardEmail author
Original Scientific Report



Surgical capacity assessment in low- and middle-income countries (LMICs) is challenging. The Surgeon OverSeas’ Personnel Infrastructure Procedure Equipment and Supplies (PIPES) survey tool has been proposed to address this challenge. There is a need to examine the gaps in veracity and context appropriateness of the information obtained using the PIPES tool.


We performed a methodological triangulation by comparing and contrasting information obtained using the PIPES tool with information obtained simultaneously via three other methods: time and motion study (T&M); provider focus group discussions (FGDs); and a retrospective review of hospital records.


In its native state, the PIPES survey does not capture the role of non-physician clinicians who contribute immensely to surgical care delivery in LMICs. The surgical workforce was more accurately captured by the FGDs and T&M. It may also not reflect the improvisations (e.g., patients sharing beds, partitioning the operating theater, and using preoperative rooms for surgery, etc.) that occur to expand surgical capacity to overcome the limited infrastructure and equipment.


The PIPES tool captures vital surgical capacity information but has gaps that can be filled by modifying the tool and/or using ancillary methodologies. The interests of the researcher and the local stakeholders’ perspectives should inform such modifications.


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • Obieze C. Nwanna-Nzewunwa
    • 1
  • Mary Margaret Ajiko
    • 2
  • Girish Motwani
    • 1
  • Fiona Kabagenyi
    • 2
  • Melissa Carvalho
    • 1
  • Isabelle Feldhaus
    • 1
  • Fred Kirya
    • 2
  • Joseph Epodoi
    • 2
  • Rochelle Dicker
    • 3
  • Catherine Juillard
    • 1
    Email author
  1. 1.Department of Surgery, Zuckerberg San Francisco General Hospital & Trauma Center, Center for Global Surgical StudiesUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.Department of SurgerySoroti Regional Referral HospitalSorotiUganda
  3. 3.Department of Surgical Critical CareUniversity of California, Los AngelesLos AngelesUSA

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