{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T07:25:45Z","timestamp":1786951545230,"version":"build-2736575974"},"reference-count":26,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,6,28]],"date-time":"2026-06-28T00:00:00Z","timestamp":1782604800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,28]],"date-time":"2026-06-28T00:00:00Z","timestamp":1782604800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Access to safe, timely, and affordable surgical care remains a challenge in low\u2010 and middle\u2010income countries (LMICs), where deficits in infrastructure and workforce are most acute at the district hospital level. From 2018 to 2024, Rwanda implemented its first National Surgical, Obstetric, and Anesthesia Plan (NSOAP) and prioritized decentralized surgical care. We aimed to conduct a post\u2010implementation national assessment of surgical infrastructure, workforce, and service delivery at Rwanda's district and level 2 teaching (L2TH) hospitals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a nationwide cross\u2010sectional survey of 43 hospitals, comprising all 34 district hospitals, and 9 L2TH in Rwanda from May\u2010June 2025, using the WHO Situational Analysis Tool for Emergency and Essential Surgical Care (SAT\u2010EESC). Five domain\u2010specific informants per facility provided infrastructure, workforce, and service delivery data, complemented by facility walk\u2010throughs and a review of operating room registers. In addition to descriptive data analysis, we compared rural and urban hospitals and mapped workforce distribution.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>All facilities had at least one functional operating room. Most facilities reported continuous electricity and running water, and oxygen cylinders were available at all times in 90.7% of facilities. Blood banks and oxygen concentrators were the least consistently available, reported as available at all times in 32.6% and 58.1% of facilities, respectively. The median facility\u2010level surgeon, anesthesiologist, and obstetrician density was 0.71 per 100,000 population, and 14 hospitals had no specialist SAO cadre. Non\u2010specialist cadres were widely available, with a median non\u2010specialist surgical workforce density of 6.76 per 100,000 population. No statistically significant urban\u2013rural workforce differences were observed, although rural facilities were significantly farther from next\u2010level referral facilities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Rwanda's district and level 2 teaching hospitals demonstrate high infrastructure readiness. However, gaps persist in the distribution of the specialist workforce, diagnostics, and advanced surgical care capacity. The findings also highlight the importance of non\u2010specialist cadres in sustaining district\u2010level surgical service delivery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/wjs.70476","type":"journal-article","created":{"date-parts":[[2026,6,28]],"date-time":"2026-06-28T16:49:09Z","timestamp":1782665349000},"page":"2338-2347","source":"Crossref","is-referenced-by-count":0,"title":["Surgical Infrastructure and Workforce Readiness in Rwanda's District and Level 2 Teaching Hospitals: A Nationwide Facility\u2010Based Survey"],"prefix":"10.1002","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-4736-8475","authenticated-orcid":false,"given":"Alexander","family":"Habtemariam","sequence":"first","affiliation":[{"name":"Center for Equity in Global Surgery University of Global Health Equity  Kigali Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0250-5805","authenticated-orcid":false,"given":"Marie 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