Dr Augustino Hellar’s journey into surgical procedure was formed by his upbringing in Tanzania, the place entry to healthcare was typically restricted. He remembers how lengthy distances to well being amenities had been a typical barrier.
“I noticed the disparity in well being care, particularly for rural communities,” he stated. “It was not unusual to seek out sufferers having to journey perhaps 10 kilometres away to seek out well being companies.”
The truth Dr Hellar witnessed as a baby isn’t distinctive to Tanzania. It displays a disaster enjoying out throughout the African continent. Round 5 billion folks, roughly two-thirds of the world’s inhabitants, lack entry to secure, reasonably priced surgical care. Africa bears a disproportionate share of that burden, served by simply 2% of the world’s surgical workforce. Surgeon-to-population ratios throughout East, Central and Southern Africa common round 0.59 per 100,000 folks. That is far under any accepted international benchmark.
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To satisfy the 143 million surgical procedures estimated to be wanted yearly in low- and middle-income nations, the world would require 2.2 million further surgeons. This scarcity contributes to unmet surgical wants, together with congenital circumstances that Operation Smile addresses.
Dr Hellar didn’t should examine this disaster in a textbook; he lived it.
That have drew him towards drugs, and inside drugs, towards surgical procedure. Right now, as Operation Smile’s Regional Director for Rwanda, Ghana, and Tanzania, Dr Hellar is on the forefront of efforts to shut the hole in entry to secure surgical procedure throughout the continent. The group at the moment operates in 10 nations in sub-Saharan Africa, together with Ethiopia, the Democratic Republic of Congo, Malawi, South Africa, Kenya, Madagascar, Mozambique, Rwanda, Ghana, and Tanzania.
He described the group’s work as constructed on 4 interconnected pillars.
The primary is service supply: offering complete cleft look after sufferers with cleft lip and palate. The second is workforce improvement, coaching surgeons, anaesthesiologists, and the complete multidisciplinary surgical crew in partnership with ministries of well being and universities. The third is infrastructure strengthening, serving to surgical groups work in secure, adequately outfitted environments. The fourth operates on the group stage, working with group well being employees to make sure sufferers who want care are recognized and attain companies.
The COSECSA partnership
A key a part of Operation Smile’s technique to strengthen surgical techniques is its partnership with the Faculty of Surgeons of East, Central and Southern Africa (COSECSA), one of many largest surgical coaching establishments within the area.
Dr Hellar stated that the partnership was a logical one.
He stated that COSECSA’s decentralized coaching mannequin permits medical doctors to coach inside accredited native hospitals reasonably than relocating to universities.
“With COSECSA, it is in all probability a lot better than university-based programmes,” he stated, “as a result of they’re skilled of their native settings. It is somebody who has grown up in all probability on this group, and so they’re coaching there. So there’s extra motivation to have the ability to keep and provide their companies.”
That is an strategy that helps retain expertise inside communities.
“One of many issues that could be a plus for this coaching physique is that you do not have to go to the college. It is a fellowship programme. You’ll be able to prepare in any hospital that’s accredited by COSECSA,” he stated. That native grounding, he argues, can also be a partial reply to the persistent downside of mind drain, the lack of African-trained medical professionals to better-resourced well being techniques elsewhere.
He additionally stated that the mannequin allows cross-country collaboration and abilities trade.
Rwanda – A blueprint for the continent
Of the three nations in his portfolio, Rwanda is the one Dr Hellar factors to most readily as a mannequin for others to observe. The nation has developed what he describes as a hub-and-spoke mannequin of surgical care – one wherein the capability to deal with sufferers is distributed throughout district-level amenities, not concentrated solely within the capital.
“That’s one thing that ought to be replicated in different nations… as a result of it will increase surgical entry,” Dr Hellar stated.
Rwanda’s technique, as he described it, is to make sure that sufferers can entry care inside a two-hour journey or a 75-kilometre radius of the place they stay. It’s an bold benchmark and one he believes ought to grow to be the usual throughout sub-Saharan Africa.
He additionally pointed to robust authorities management as a vital success issue.
“One of many issues that we’re seeing in Rwanda is the federal government management, the Ministry of Well being, taking the lead. It’s extremely robust in Rwanda, and I believe that’s one thing that different nations also can be taught from,” he stated.
The federal government engagement was evident in early 2025, when Operation Smile convened the primary Pan-African Surgical Convention in Kigali, alongside Rwanda’s Ministry of Well being, the Surgical Society and the College of Rwanda. The five-day occasion introduced collectively greater than 500 surgeons, policymakers and well being employees from 36 nations to work towards sensible options for increasing surgical entry throughout the area.
Regardless of progress, important challenges stay.
Dr Hellar recognized 5 main challenges in delivering surgical care throughout the African continent.
The primary and largest is the surgical workforce itself. “We’ve got only a few surgeons, anaesthesiologists, nurses who’re working within the surgical area,” he stated. “That is likely one of the greatest challenges.” Nonetheless, coaching partnerships just like the COSECSA collaboration are the first lever for addressing this.
The second is infrastructure, notably at district and community-level amenities. “Possibly within the main cities you discover hospitals which are well-equipped, however when you go all the way down to the district stage, you’ve got restricted theatre area, ICU capability, gear challenges,” he defined.
Third is late affected person presentation. That is the tendency for sufferers to reach at amenities with circumstances which have progressed far past what early intervention might have addressed. This, he stated, is itself a consequence of poor entry. “Sufferers are likely to current late as a result of in all probability they do not have entry to easily-reached care,” he stated, calling for stronger group consciousness campaigns and referral techniques.
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Fourth is the availability chain. “We’ve got weak provide chain techniques,” he stated. He added that working with governments to develop focused partnerships is a part of the answer.
The fifth barrier is monetary. Throughout sub-Saharan Africa, giant numbers of rural sufferers lack medical insurance and can’t afford the price of surgical care. “Looking for revolutionary methods, like common well being entry, to assist financing mechanisms for healthcare is one thing that’s fairly wanted,” stated Dr Hellar.
A imaginative and prescient for African surgical procedure
Dr Hellar’s imaginative and prescient for the way forward for surgical care throughout Africa is articulated by way of what sufferers ought to not should endure.
“One of many greatest issues that I’d want to see sooner or later is elevated entry to care… Sufferers should not have to spend days… they don’t have to grow to be poor as a result of they promote their cows, promote their homes… in order that they will afford surgical care,” he stated.
His imaginative and prescient is to make sure that surgical companies can be found inside a radius of 75 kilometres, in sub-Saharan Africa, utilizing a hub-and-spoke mannequin pioneered in Rwanda.
“If that’s achieved throughout sub-Saharan Africa… it would lower the surgical burden and impression of surgical mortalities and morbidities,” stated Dr Hellar.
