Repairing the Surgery Deficit SARIKA BANSAL New York Times August 8,

Shortage of Surgeons Across Africa, countless people die or become disabled because they cannot obtain necessary surgeries. It is conservatively estimated that 56 million people in sub-Saharan Africa — over twice the number living with H.I.V./AIDS — need a surgery today. conservatively estimated Some need cesarean sections or hernia repairs, while others require cataract surgery or treatment for physical trauma.

Implications Cannot do surgeries like cesarean sections. Smaller health facilities often have no choice but to refer patients to larger cities. Surgical equipment is sometimes nonexistent, especially in remote areas, and supplies are a challenge to maintain. More critical, though, is the human resource gap. Zambia has only 44 fully licensed surgeons to serve its population of 13 million, who are spread over an area slightly larger than Texas.

The Shortage Finding fully licensed surgeons is not easy. Not only is the absolute number of surgeons low, but the distribution is also very uneven. Only 6 of Zambia’s 44 surgeons live in rural areas, and all of them are expatriate missionaries. Fully licensed doctors are also in high demand in other lines of work. Some leave public sector clinical practice to pursue careers in administration, private clinical practice and international NGO work — all of which can be more lucrative.

Task Shifting Instead of finding ways to lure surgeons to rural areas, many African countries have started experimenting with “task shifting” — that is, training non-physicians to do the basic work of surgeons. In Zambia, surgical task shifting began in 2002 with the medical licentiate program, which trains clinical officers in basic surgeries like hernia repairs, bowel obstruction surgery, hysterectomies and more. The Surgical Society of Zambia and the Ministry of Health jointly determined the procedures in which licentiates should be trained. For instance, the program emphasizes training in cesarean sections, which constitute 45 percent of major surgeries in the country.

The Economics What does licensing do? Labor Market Labor Wage L1L1 W1W1 Shifts supply to the left. Why? D1D1 S1S1

What are impacts of licensing? Smaller supply. Possible monopoly rents. Better information on quality of care. So, if we relax licensing, what can happen?