Nearly five billion people lack timely access to safe, affordable surgery, while low-income countries perform only about 6% of procedures worldwide despite an estimated annual shortfall of 143 million operations.

A synthesis of 94 peer-reviewed studies published from 2005 to 2025 finds that regional training partnerships, task-sharing, digital education and national planning can help address severe shortages of surgical, obstetric and anesthesia personnel in low- and middle-income countries.

Regional training programs have helped retain clinicians: the College of Surgeons of East, Central, and Southern Africa trained surgeons in their home settings and reported 88% regional retention, with more than 1,048 graduates in later totals; programs partnered with the Pan-African Academy of Christian Surgeons reported retention as high as 95%.

Task-sharing has also shown promise: in Malawi and Zambia, trained clinical officers performed emergency and elective procedures with safety outcomes comparable to medical officers, and wound infection rates did not differ significantly between provider groups. The studies were not powered to detect differences in mortality.

Digital and low-cost training are extending access, with an e-learning curriculum reaching 96% of enrolled trainees across 17 African countries and improving examination pass rates, while locally made simulation models costing under $20 each trained more than 100 anesthesia providers; remote mentoring also supported complex procedures across South Asia.

Partnerships need to be more reciprocal: a cited review found genuine two-way exchange in only one of 28 traditional North-South partnerships, and fewer than half of surveyed clinicians said visiting teams understood local contexts. South-South collaborations have supported regional retention but face financing and cross-border licensing barriers.

Gender inequities remain pronounced, with women making up about 10% of specialist surgeons in surveyed African countries from 2015 to 2022; the review highlights mentorship and leadership initiatives such as Women in Surgery Africa, alongside the need for institutional resources and support for diverse cadres in underserved areas.

National Surgical, Obstetric, and Anesthesia Plans can put workforce targets into health policy, but sustained progress requires public financing and ongoing evaluation: in East, Central, and Southern Africa, a 42% rise in practicing surgeons from 2015 to 2022 increased specialist density only from 0.53 to 0.59 per 100,000, partly because of population growth.

The review searched PubMed, Scopus and Google Scholar for studies published from January 1, 2005, to March 31, 2025, screening 1,114 citations and assessing 395 full texts before retaining 94 studies; varied research designs and outcomes led the authors to use thematic synthesis rather than a quantitative meta-analysis.

The authors caution that the review may miss local evidence because it included only English-language studies indexed in major international databases, lacked a preregistered protocol and PRISMA framework, and may overrepresent successful programs because failures are less likely to be published.