Thorac cardiovasc Surg 2014; 62(05): 393-401
DOI: 10.1055/s-0034-1383723
Special Report
Georg Thieme Verlag KG Stuttgart · New York

Cardiac Surgery Capacity in Sub—Saharan Africa: Quo Vadis?

Charles Yankah1, 2, Francis Fynn-Thompson3, Manuel Antunes4, Frank Edwin5, Christine Yuko-Jowi6, Shanthi Mendis7, Habib Thameur8, Andreas Urban9, Ralph Bolman III10
  • 1Department of Thoracic and Cardiovascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
  • 2Department of International Relations, Afrika Kulturinstitut e.V, Berlin, Germany
  • 3Department of Cardiac Surgery, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, United States
  • 4Department of Cardiothoracic Surgery, University Hospital of Coimbra, Coimbra, Portugal
  • 5Department of Cardiothoracic Surgery, National Cardiothoracic Centre, Accra, Ghana
  • 6Department of Pediatric Cardiology, University of Nairobi and Mater Hospital, Nairobi, Kenya
  • 7Department of Management of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
  • 8Department of Cardiac Surgery, Clinique Internationale Hannibal, Tunis, Tunisia
  • 9Department of Pediatric Cardiac Surgery, International Operation Centre for Children, Asmara, Eritrea
  • 10Department of Cardiac Surgery, Brigham and Women's Hospital, Boston, United States
Further Information

Publication History

17 April 2014

31 May 2014

Publication Date:
23 June 2014 (eFirst)


Background Current data on cardiac surgery capacity on which to base effective concepts for developing sustainable cardiac surgical programs in Africa are lacking or of low quality.

Methods A questionnaire concerning cardiac surgery in Africa was sent to 29 colleagues—26 cardiac surgeons and 3 cardiologists in 16 countries. Further, data on numbers of surgeons practicing in Africa were retrieved from the Cardiothoracic Surgery Network (CTSNet).

Results There were 25 respondents, yielding a response rate of 86.2%. Three models emerged: the Ghanaian/German model with a senior local consultant surgeon (Model 1); surgeons visiting for a short period to perform humanitarian surgery (Model 2); and expatriate surgeons on contract to develop cardiac programs (Model 3). The 933 cardiothoracic surgeons listed by CTSNet translated into one surgeon per 1.3 million people. In North Africa, the figure was three surgeons per 1 million and in sub-Saharan Africa (SSA), one surgeon per 3.3 million people. The identified 156 cardiac surgeons represented a surgeon to population ratio of 1:5.9 million people. In SSA, the ratio was one surgeon per 14.3 million. In North Africa, it was one surgeon per 1.1 million people. Open heart operations were approximately 12 per million in Africa, 2 per million in SSA, and 92 per million people in North Africa.

Conclusion Cardiothoracic health care delivery would worsen in SSA without the support of humanitarian surgery. Although all three models have potential for success, the Ghanaian/German model has proved to be successful in the long term and could inspire health care policy makers and senior colleagues planning to establish cardiac programs in Africa.