Articles
Vol. 48 No. 1 (2026)
From outreach to ownership: building sustainable paediatric surgical capacity at a secondary hospital in rural Tanzania. A ten-year experience
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 13 May 2026
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Sub-Saharan Africa has a critical shortage of paediatric surgical resources. Specialists are concentrated in urban centres, leaving rural areas underserved; peripheral hospitals lack trained providers, contributing to suboptimal care. Underdiagnosis and limited surveillance conceal the true disease burden. Short-term outreach has not produced sustainable improvements. Consistent with the Global Surgery 2030 framework, this study holds that sustainable paediatric surgical access requires a deliberate transition from episodic, vertical outreach to a horizontal, locally governed system that is embedded within existing health services and referral networks. This retrospective programme evaluation investigates how a participatory approach at a secondary hospital in Tanzania's rural context can strengthen local providers’ capacity and enable the facility to serve as a paediatric surgical hub. A 404-bed charitable secondary-level hospital in the Southern Tanzanian Highlands, 800 km from the nearest tertiary centre, hosted the programme from 2016 to 2026. It evolved from short-term outreach into ongoing training, mentorship, and joint goal-setting, through which local staff acquired skills to manage paediatric cases via surgical tutoring, anaesthesia upgrading, nurse empowerment, and remote consultation. Paediatric procedures rose from 7.2% to 11.9% of total surgical activity (two-sided p<10–16), with a 102.4% increase in general surgical and urological procedures. Local surgeons are now performing all procedures autonomously. The most recent caseload includes many major conditions, with generally favourable outcomes; however, neonatal mortality remains high, mainly due to late referrals and the absence of dedicated postoperative facilities. A participatory approach identified previously unrecognised needs and supported the development of sustainable local capacity. Ongoing training, structured mentorship, and a gradual transfer of responsibility enhanced autonomous practice and increased patient recruitment. Context-sensitive partnerships and sustained educational investment supported skill retention, institutional learning, and the integration of new practices into routine care. These elements are essential to expanding paediatric surgical services in under-resourced settings.
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CRediT authorship contribution
All authors contributed equally to the work.
How to Cite
From outreach to ownership: building sustainable paediatric surgical capacity at a secondary hospital in rural Tanzania. A ten-year experience. (2026). La Pediatria Medica E Chirurgica, 48(1). https://doi.org/10.4081/pmc.2026.377
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