Every year, millions of people in Sub-Saharan Africa need surgery — for complicated childbirths, traumatic injuries, or life-threatening conditions like appendicitis — but never receive it. An estimated 93% of people in the region lack access to safe and affordable surgical care. One of the main reasons is a severe shortage of trained surgical providers, particularly in rural and district hospitals far from major cities.

A promising solution — one that challenges how we traditionally think about surgery — is called surgical task sharing: training non-specialist health workers, such as nurse-midwives, associate clinicians, and non-specialist doctors to safely perform specific surgical procedures. In Sierra Leone, these providers are known as Community Health Officers (CHOs). Programmes built on this model have been running in Sierra Leone since 2011, led by CapaCare in collaboration with NTNU, and similar initiatives exist across Ethiopia, Malawi, Mozambique, and Zambia, implemented at varying scales by governments, NGOs, and academic institutions. Yet a critical question remains largely unanswered: does surgical task sharing actually reduce health inequalities, and if so, for whom?

This PhD project, led by PhD-student Alberto Inzulza Galdames at NTNU, examines that question at three levels simultaneously (see Table I). At the continental level, it maps how all 49 Sub-Saharan African countries are implementing surgical task sharing, and whether this is associated with reductions in the surgical burden of disease. At the country level, it zooms into Sierra Leone, tracking district-by-district whether the introduction of specially trained surgical providers has reduced maternal mortality and narrowed the gap between the richest and poorest populations. At the individual level, it asks who actually gains access to surgical training, and whether task sharing is opening new career pathways for health workers from diverse backgrounds. Together, these interconnected studies aim to generate robust, equity-focused evidence that policymakers can use to design, scale, and sustain surgical task-sharing programmes across the continent — bringing surgery closer to the people who need it most, and addressing one of the world's most persistent health inequalities.

External collaborator: CapaCare, A dynamic International Non-Governmental Organization with a focus on medical training and research in Sub-Saharan Africa.

Table I: Project implementation levels